SuperBugs& antimicrobial resistance

Data from CDC’s“ANTIBIOTIC RESISTANCE THREADIn the United States”, 2013

Dr. Giuliani Francesco Ph.D

Molteni Therapeutics BU riceca PDTMail: f.giuliani@moltenitherapeutics.itPhone: +39 055 7361 - 239Skype: Moltenitherap

Molteni Therapeutics S.R.L. Via I. Barontini, 8 – Loc. Granatieri50018 Scandicci (FI) Tel. +39 055 7361285

Website: www.moltenitherapeutics.it

Mail: info@moltenitherapeutics.it

Let’s define a drug-resistant bacteria “superbug” Bacterial strain genetically resistant to one or more classes of antimicrobial agents. Difficult to fight High mortality rates: killing half people with serious infections Can spread its resistance to other bacteria Most present in hospital environments causing healthcare-associated infections

Superbugs“Multidrug-resistant” (MDR)Non-susceptibility to at least one agent in three or more antimicrobial categories

“Extensive drug-resistant” (xdr)Non-susceptibility to at least one agent in all but two or fewer antimicrobial categories

“pandrug-resistant” (PDR)Non-susceptibility to all agents in all antimicrobial categories

The Threat of ANTIBIOTIC RESISTANCE

Worldwide problem Many form of resistance spread with remarkable speed World health leaders describe multidrug-resistant microorganisms as “nightmare bacteria” that “pose a catastrophic treat” to people in every country in the world

United states National summary data

Estimated minimum number of illnesses and deaths caused by antibiotic resistance:

At least 2,049,442 illnesses

23,000 deaths

Estimated minimum number of illnesses and deaths due to Clostridium difficile

At least 250,000 illnesses

14,000 deaths

+

misUse of antibiotics is the single most important factor leading to antibiotic resistance around the world

The other major factor

is spread of resistant strains of bacteria

Developing resistance

Timeline of Key Antibiotic Resistance EventsDates are based upon early reports of resistance in the

literature. In the case of pan drug-resistant (PDR)-

Acinetobacter and Pseudomonas, the date is

based upon reports of healthcare transmission or

outbreaks. Note: penicillin was in limited use prior to

widespread population usage in 1943.

People at Especially

High Risk

Bad bugs, no drugs: no eskapeThere are few medicine in development to treat resistamt form of bacteria. Of particular importance are the so-called ESKAPE bacteria many of them are MDR

Enterococcus, including E. faecium Staphylococcus aureus Klebsiella, including K. pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Enterobacter species, including E. cloacae

Cause the majority of nosocomial infections

Regarding level of concerns bacteria are prioritized into one of three categories

Urgent threatsThese are high-consequence antibiotic-resistant threats.

Serious threatsThese are significant antibiotic-resistant threats.

Concerning threatsThese are bacteria for which the threat of antibiotic resistance is low, and/or there are multiple therapeutic options for resistant infections.

Microorganisms with

a threat level of urgentClostridium difficileCarbapenem-resistant EnterobacteriaceaeDrug-resistant Neisseria gonorrhoeae

These bacteria are immediate public

health threats that require urgent and aggressive action.

None of the pathologies sustained by these microorganisms is of easy

access for Photodynamic therapy

Life threatening diarrhea Bloodstream infections Gonorrhea

Microorganisms with

a threat level of seriousMultidrug-resistant AcinetobacterDrug-resistant CampylobacterFluconazole-resistant Candida (a fungus)Extended spectrum β-lactamase producing Enterobacteriaceae (ESBLs)Vancomycin-resistant Enterococcus (VRE)Multidrug-resistant Pseudomonas aeruginosaDrug-resistant non-typhoidal SalmonellaDrug-resistant Salmonella TyphiDrug-resistant ShigellaMethicillin-resistant Staphylococcus aureus (MRSA)Drug-resistant Streptococcus pneumoniaeDrug-resistant tuberculosis

These bacteria are a serious concern and require prompt and sustained action to ensure the problem

does not grow.

Photodynamic therapy may be useful in the treatment of

Surgical procedure infections (P. aeruginosa) Skin and wound infections (MRSA) Candidiasis (C. albicans)

Microorganisms with a threat level of

Concerning

Vancomycin-resistant Staphylococcus aureus (VRSA)Erythromycin-resistant Group A StreptococcusClindamycin-resistant Group B Streptococcus

These bacteria are concerning, and

careful monitoring and prevention

action are needed.

Photodynamic therapy may be useful in the treatment of

Medical procedure-derived infections (VRSA) Surgical procedure infections (VRSA) Skin infections (Group A Streptococcus and

Group B Streptococcus) Necrotizing fasciitis (Group A Streptococcus )

Questions?

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