Antimicrobial Resistance

Rita Huytonrita.huyton@phe.gov.ukSept 2014

Hit the Headlines

Objectives

Give an overview of antimicrobial resistance:

- How bugs become resistant

- Why it matters

- What we can do about it

- Acknowledgements Dr Bharat Patel, Consultant Medical Microbiologist, AMR & HCAI Lead for PHL London

How bugs become resistant…..

Antibiotic Resistance is AncientD’ Costa at el (2011) Nature Vol. 477, Issue 7365

Inactivation EffluxImpermeability

By-pass Altered targetPbps

Resistance mechanisms

A B

1. ᵦ-lactamase2. ESBL3. Carbapenemase

Resistant Strains Rare

xx

Resistant strains dominant

Antimicrobial Exposure

xxxx

xx

xx

xx

Selection for antimicrobial-resistant strains

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

www.cdc.govMultiple resistance carried

New Resistant Bacteria

Mutations

XX

Emergence of Antimicrobial Resistance Susceptible Bacteria

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

Resistant Bacteria

Resistance Gene Transfer

www.cdc.gov

Plasmid exchange

ccbcmd.edu

Why it matters…..

Bacteria have been around for 3 billion years - antibiotics for 6 decades

“success and speed of bacterial adaptation”

Bennett P M (2008) Plasmid encoded antibiotic resistance: acquisition and transfer of antibiotic resistance genes in bacteria. British Journal of Pharmacology (2008) 153, S347–S357 www.brjpharmacol.org

Why it matters…..

Humans are walking petri dishes – there are 10 times more bacterial cells in our bodies than human cells

Wenner M (207) Humans Carry more bacterial cells than human ones. Scientific American http://www.scientificamerican.com/article/strange-but-true-humans-carry-more-bacterial-cells-than-human-ones/

Increasing resistance …………

MRSA / GISA / VRSA

GRE

ESBLS

CPE

BSI England, Wales, N. Ireland 2011-12

Antimicrobial Resistance

Antibiotic resistance: Cameron warns of medical 'dark ages‘

BBC News 02/07/2014

CMO Professor Dame Sally C. Davies – first annual report (2011) published in 2012

What can we do about it?

Be alert – VIM, VRE, IMP, KPC

Share information – transfer and discharge

Get IPC right! – do the basic AND do then well

Protect the use of antibiotics

What can we do about it ?Reduce expectation – make every contact count

Live well – smoking, exercise

Immunisation

IPC – provider & commissioners

Specimen collection

Prevent readmissions

Dispensing – right time, stop dates, challenge

The end…….

www.cidrap.umn.edu