How does Antibiotic Resistance affect you?

1
How does Antibiotic Resistance affect you?

• Target Audience Adult General Public
• Lillian Ortega, MPH student
• Walden University
• Aspects of Environmental Health Local to Global
  (PUBH - 6165 - 5).
• Instructor Dr. Donald Goodwin
• Summer 2010

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Objectives

• Define antibiotic resistance
• Describe potential mechanism
• Evaluate the importance of antibiotic resistance
  on the global, national and local communities.
• Describe the impact of antibiotic resistance on
  Public Health
• Prevention and Educational tools
• Online Resources to further your knowledge on
  antibiotic resistance

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What Is Antibiotic Resistance?

• Antibiotics/ Antimicrobials kill or stop growth
  of bacteria, fungi and parasites (Center for
  Disease Control and Prevention,2009).
• Microorganisms respond to antibiotics by mutating
  or changing the way they attack the body in
  order for them to survive on earth (Chambers,
  2010).
• Mutations allow the microorganisms to find ways
  around being killed by antibiotics, once this
  occurs the microorganism is now seen as resistant
  to that antibiotic (Chambers, 2010).

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Antibiotic Resistant Terms

• Community Acquired patient has not been
  hospitalized or undergone a medical procedure
• Hospital Acquired- patient has been hospitalized
  and/orhas had a medical procedure
• Multidrug Resistance- the organism is no longer
  susceptible to the panel of drugs known as the
  first line of treatment which is used commonly to
  treat the infection.
• Extensive Drug Resistance- the organism is no
  longer susceptible to the panel of drugs used as
  the first line as well as drugs used on the
  second line of treatment.
• Ex XDR TB, MDR TB and MDR- Malaria
• (Wongsrichanalai , Varma , Juliano , Kimerling
  MacArthur ,2010)

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Contributing Factors To The Pattern Of Antibiotic
Resistance

• Improper use of antibiotics
• Healthcare providers-prescribing antibiotics for
  virus infections like colds, sore throats and
  upper respiratory infections when antibiotics are
  most effective against bacterial infections and
  are not effective against common viral
  infections.
• Individuals- not completing dose regimen as
  prescribed or using antibiotics not prescribed to
  them exposes microorganisms to the antibiotic
  which in turns allows the microorganism to mutate
  and develop resistance against them (Center for
  Disease Control and Prevention ,2009).
• Overuse of antibiotics
• Farmers- about 2.5 million kilograms of
  antibiotics are used each year on livestock in
  the United States but only 10 (250,000 kg) is
  actually being used as treatment therapy for
  infections (U. S. Environmental Protection
  Agency, 2004).

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Which Organisms Are Impacting Public Health On
The National Level?

• Methicillin Resistant Staphylococcus aureus (
  MRSA)
• MDR and XDR Tuberculosis
• MDR Plasmodium falciparum
• Vancomycin Resistant Entercoccus (VRE)
• Table 1 Healthcare-Associated Infection (HAI)
  Reported to the
• National Healthcare Safety Network, January
  2006October 2007
• (Hidron et al, 2008)

Pathogenic Organism of Reported Pathogenic Organisms tested for Resistance of Reported Pathogenic Organisms with Resistance Percentage of Pathogenic Organism with Resistance
S.aureus 2736 1537 56.2
Entercoccus faecium 969 775 80.0
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Emergence Of MRSA In US From 1998- 2005

• Data from the Surveillance Network-USA (TSN) was
  used to monitor the MRSA incidence data from
  over 300 microbiology laboratories around the USA
  from 1998-2005, which included reports from
  inpatient and outpatient microbiology specimen.
• Table 2 Percentage of laboratory confirmed MRSA
  isolates reported to the Surveillance Network
  USA from 1998-2005
• (Styers, Sheehan, Hogan, Sahm, 2006).

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Which Organisms Are Becoming National Threats?

• Table 2 TB cases reported to CDC in 2008 with
  drug susceptibility
• (Center for Disease Control and Prevention,
  2009).
• Malaria and tuberculosis (TB) are two of the most
  common infectious diseases in the global
  community, that are threatening the United
  States.
• In the global community each year, gt1.7 million
  persons die of TB and approximately 1 million are
  loss to malaria
• Increase resistance presents itself as a hurdle
  to effectively contain these diseases.
• (Wongsrichanalai et al, 2010)

Reporting Area of TB cases reported in 2008 of TB cases Resistant to INH of TB cases with MDR
US 9365 782 103
MD 218 19 4
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Impact Of Antibiotic Resistance In The Global
Community (MDR- Malaria Plasmodium falciparum)

• The impact of drug resistance in the global
  community can be seen through the transformation
  of reported cases compared to other species that
  cause malaria.
• For example, in India the reported case of P.
  falciparum is responsible for in excess of 50 of
  malaria reported cases compared to 23 reported.
• Between 1996 and 2004 over 50 countries around
  the world altered their standard treatment for P.
  falciparum malaria due to impact of MDR
  P.falciparum in monitoring reports.
• (World Health Organization, 2005)

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Impact Of Antibiotic Resistance In The Global
Community ( MDR and XDR Tuberculosis)

• A study evaluating the global impact of MDR and
  XDR TB tested 17,690 Mycobacterium tuberculosis
  isolates from different regions of the world.
• 20 were MDR- TB and 2 were XDR-TB
• XDR TB cases has risen from 14 reported cases in
  2000 to 34 in 2004 world wide.
• The World Health Organization reports that
  currently 1/3 of the worlds population has been
  infected with TB and it is a major global threat.
  
• The threat of XDR-TB sounds a major alarm to
  Public Health and has the global community
  concerned because it could lead to an increase in
  the amount of untreatable TB cases worldwide.
• (Wright et al, 2006)

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Global Response To Antibiotic Resistance

• World Health Organization ( WHO)
• 1990s recognized antibiotic resistance as a
  significant emerging public health threat around
  the world.
• 2001 organized WHO Global Strategy for
  Containment of Antimicrobial Resistance.
• Committee provided 68 recommendations to control
  antibiotic resistance aimed at governments,
  hospitals, national agencies, health care systems
  etc.
• (World Health Organization, 2001)

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Scope Of Antibiotic Resistance

• An investigation was conducted to truly access
  the magnitude of Extensive Drug Resistance
  Tuberculosis in the state of California.
• Evaluated TB case reports that the state TB
  registry had access to between the years of 1993
  and 2006.
• Table 3 Extensive Drug Resistance Tuberculosis
  (XDR-TB) reported cases in the state of
  California from 1993 thru 2006
• Pre-XDR TB are resistant to isoniazid, rifampin
  and either a fluoroquinolone or second-line drug
  but not both.
• XDR-TB are resistant to isoniazid, rifampin, a
  fluoroquinolone, and 1 of 3 second-line drugs
  (amikacin, kanamycin, or capreomycin)(Banerjee et
  al, 2008).

Confirmed new TB cases from 1993-2006 Confirmed XDR-TB cases from 1993-2006 Confirmed Pre XDR- TB cases from 1993-2006
424 18 77
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U.S. Response To Antibiotic Resistance

• Some of the agencies involved in controlling the
  reach of antibiotic resistant organism
• Center for Disease Control and Prevention (CDC)
• Food and Drug Administration (FDA)
• Department of Defense (DoD)
• Veterans Affairs (VA)
• Department of Agriculture ( USDA)
• Lead to the development of projects to address
  Antibiotic Resistance on the domestic level.
  Containment and controlling antibiotic resistance
  is the forefront of this mission, tackling it in
  the hospitals, nursing homes and even the
  communities.
• (Center for Disease Control and Prevention,
  2009)

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How Does Antibiotic Resistance Affect the Local
Community?

• Antibiotic Resistance is no longer confined to
  hospitals and nursing homes.
• Antibiotic Resistance is everywhere no community
  or nation is immune to it.
• Due to globalization a person can fly around the
  world in 24 hours and so can their germs.
• The threat of Community Acquired infections is
  escalating as children in daycare centers are at
  risk and local gyms can become a host for an
  outbreak.
• (Center for Disease Control and Prevention ,2009)

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How Does Antibiotic Resistance Affect You?

• What happens if you or a family member acquires
  an antibiotic resistant organism?
• The infection becomes difficult to treat due to
  the resistance of the organism (Center for
  Disease Control and Prevention ,2009).
• May lead to an extended hospital stay to receive
  Intravenous antibiotics or second line
  antibiotics.
• Second line antibiotics maybe more toxic to the
  body.
• If not caught in time can lead to severe
  infections of the blood and even lead to death
  (Gandara et al., 2006).

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What Can You Do To Protect Yourself?

• Educate yourself about the proper use of
  antibiotics
• Dont be afraid to question if antibiotics are
  truly necessary if you doctor is prescribing
  antibiotics for you.
• If you are prescribed antibiotics take them as
  indicated on the label.
• Dont share antibiotics.
• Take care of yourself by eating healthy foods,
  get enough rest, exercise and good hygiene.
• Avoid infection as much as possible by properly
  washing your hands before and after daily
  activities!!!
• (Center for Disease Control and Prevention ,2009)

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How Can You Get Involve In The Fight To Control
Antibiotic Resistance?

• Contact Marylands Community Health
  Administration at 410-767-5300 or visit
  http//cha.maryland.gov/mailus/write.cfm
• to contact your countys Health Officer about
  volunteering for educational campaigns that
  target proper antibiotic use and antibiotic
  resistance.
• Useful links for more information
• http//www.cdc.gov/getsmart/
• http//www.fda.gov/Drugs/ResourcesForYou/Consumers
  /BuyingUsingMedicineSafely/AntibioticsandAntibioti
  cResistance/default.htm
• http//www.niaid.nih.gov/topics/antimicrobialresis
  tance/understanding/pages/default.aspx
• The goal is to inhibit the emergence and spread
  of resistant organisms, and encourage proper
  antibiotic use as to reduce resistance!!!
• (Center for Disease Control and Prevention ,2009)

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References

• Banerjee, R., Allen, J., Westenhouse, J.,Oh, P.,
  Elms, W., Desmond, E., Flood, J.(2008).
  Extensively drug-resistant tuberculosis in
  California, 1993-2006.Retrieved from World Wide
  web on July 30,2010 at http//www.ncbi.nlm.nih.gov
  /pubmed/18616396
• Center for Disease Control and Prevention (CDC)
  (2009). CDC Launches the "Get Smart Know When
  Antibiotics Work" Program. Retrieved from the
  World Wide Web on July 15, 2010 at
  http//www.cdc.gov/news/2009/10/getsmart/
• Center for Disease Control and Prevention.
  (2009). Tuberculosis Reported Tuberculosis in
  United States, 2008. Retrieved from World Wide
  Web on July 28, 2010 at http//www.cdc.gov/tb/stat
  istics/reports/2008/default.htm
• Center for Disease Control and Prevention (2009).
  Implementation of a Public Health Action Plan to
  Combat Antimicrobial Resistance Progress through
  2008. Retrieved from World Wide Web July 17, 2010
  at http//www.cdc.gov/drugresistance/actionplan/20
  08report/Inventory_of_Projects_AR2008_01152010_fin
  al.pdf
• Chambers, H.F. (2010, April) Origins of
  Antimicrobial Resistance Antimicrobials as
  Agents of Selection and Direct Evolution.
  Presented at the Institute of Medicine meeting on
  Antimicrobial Resistance Implications for Global
  Health Novel Intervention Strategies in
  Washington D.C.

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References

• Gandara, A., Mota, L.C., Flores, C., Perez, H.R.,
  Green, C.F. Gibbs, S.G. (2006). Isolation of
  Staphylococcus aureus and Antibiotic-Resistant
  Staphylococcus aureus from Residential Indoor
  Bioaerosols. Environmental Health Perspectives,
  114(12).
• Hidron , A.I., Edwards, J.R., Patel, J., Horan,
  T.C., Sievert, D.M., Pollock, D.A. Fridkin,
  S.K. (2008). Antimicrobial Resistant Pathogens
  Associated with Healthcare- Associated
  Infections Annual Summary of Data Reported to
  NHSN at CDC, 2006-2007. Retrieved from World Wide
  Web on July 29,2010 at http//www.cdc.gov/nhsn/dat
  aStat.html
• Styers, D., Sheehan, D.J., Hogan, P. Sahm, D.F.
  (2006). Laboratory-based surveillance of current
  antimicrobial resistance patterns and trends
  among Staphylococcus aureus 2005 Status in the
  United States. Annals of Clinical Microbiology
  and Antimicrobials 2006, 5 (2).
• U. S. Environmental Protection Agency. (2004).
  Risk Assessment Evaluation for Concentrated
  Animal Feeding Operations. Retrieved from World
  Wide Web on July 16, 2010 at http//www.epa.gov/nr
  mrl/pubs/600r04042/600r04042.pdf
• Wongsrichanalai C., Varma J.K., Juliano J.J.,
  Kimerling M.E. MacArthur J.R. (2010) Extensive
  drug resistance in malaria and tuberculosis.
  Retrieved from World Wide Web on July 29, 2010 at
  http//www.cdc.gov/eid/content/16/7/1063.htmcit
• World Health Organization. (2001). WHO Global
  Strategy for Containment of Antimicrobial
  Resistance. Retrieved from World Wide Web on
  July16, 2010 at http//www.who.int/drugresistance/
  WHO_Global_Strategy.htm/en/index.html
•  

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References

• World Health Organization.(2005).Susceptibility
  of Plasmodium falciparum to antimalarial drugs
  1996-2004. Retrieved from World Wide Web on July
  30, 2010 at http//whqlibdoc.who.int/publications/
  2005/9241593466_eng.pdf
• Wright,A. ,Bai,G., Barrera,L .,Boulahbal,F.,
  Martín-Casabona,N. Gilpin,C., Van Deun,
  (2006).Emergence of Mycobacterium tuberculosis
  with extensive resistance to second-line drugs -
  worldwide, 2000-2004. (2006). Retrieved from
  World Wide Web on July 30, 2010 at
  http//www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.
  htm