THE ANTIBIOTIC RESISTANCE CRISIS THE ANTIBIOTIC RESISTANCE CRISIS HISTORY OF BACTERIA HISTORY OF...
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Transcript of THE ANTIBIOTIC RESISTANCE CRISIS THE ANTIBIOTIC RESISTANCE CRISIS HISTORY OF BACTERIA HISTORY OF...
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THE ANTIBIOTIC
RESISTANCE CRISIS
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THE ANTIBIOTIC RESISTANCE CRISIS
• HISTORY OF BACTERIA
• HISTORY OF ANTIBIOTICS
• RESISTANCE
• THE PROBLEM NOW
• NEVADANS FOR ANTIBIOTIC AWARENESS
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HISTORY OF BACTERIA
BACTERIA HAVE BEEN AROUND LONGER
THAN ANY LIVING THING ON EARTH.
FOSSIL EVIDENCE DATES BACK 3.5 BILLION
YEARS.
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HISTORY OF BACTERIA
EARTH AS A DAY:
5:00 AM - BACTERIA APPEAR
10:00 PM - DINOSAURS APPEAR
11:59 PM - HUMANS APPEAR
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HISTORY OF BACTERIA
REPRODUCTION
BINARY FISSION CLONE OF ORIGINAL WITH SAME DNA
FAST PROCESS ONE BACTERIUM CAN PRODUCE ONE BILLION CLONES IN TEN HOURS
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HISTORY OF BACTERIA
REPRODUCTION
MUTATION A CHANGE, SO THAT THE “NEW” BACTERIA IS SLIGHTLY DIFFERENT THAN THE ORIGINAL
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HISTORY OF BACTERIA
REPRODUCTION
IF THE ENVIRONMENT IS RIGHT, THE “NEW” BACTERIA MAY SURVIVE BETTER AND REPRODUCE, PASSING ALONG THE MUTATION
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HISTORY OF ANTIBIOTICS
1928 – DR. FLEMING DISCOVERS PENICILLIN FROM BREAD MOLD
1944 – U.S. MILITARY TAKES PENICILLIN TO THE BATTLEFIELD
1945 – BACTERIA WITH RESISTANCE TO PENICILLIN ISOLATED
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HISTORY OF ANTIBIOTICS
1960s – METHICILLIN INTRODUCED
1991 – 29% OF STAPH AUREUS RESISTANT
2001 – 62% OF STAPH AUREUS RESISTANT
RESISTANCE
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HISTORY OF ANTIBIOTICS
RESISTANCE
BACTERIA MUTATE TO PROTECT THEMSELVES FROM ANTIBIOTICS
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HISTORY OF ANTIBIOTICS
RESISTANCE
THE MUTATED BACTERIA SURVIVE AFTER THE ANTIBIOTICS ARE GONE
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HISTORY OF ANTIBIOTICS
RESISTANCE
EVENTUALLY THERE ARE MORE ANTIBIOTIC-RESISTANT BACTERIA THAN NON-RESISTIANT
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HISTORY OF ANTIBIOTICS
RESISTANCE
THE MUTATED BACTERIA REPRODUCE, PASSING ALONG THE RESISTANCE TO THEIR OFFSPRING
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HISTORY OF ANTIBIOTICS
RESISTANCE
BACTERIA CAN ALSO SWAP GENES, UNDER THE RIGHT CONDITIONS, SO DRUG-RESISTANT GERMS CAN SHARE THEIR RESISTANCE MECHANISMS
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THE PROBLEM NOW
PSEUDOMAS AEROGINOSA
13 1416
18.516
2326
28
CEFTAZIDIME IMIPENEM
% R
ES
IST
AN
CE
1991 1999 2000 2001 1991 1999 2000 2001
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THE PROBLEM NOW
STREPTOCOCCUS PNEUMONIA
32
42
22
29
PENICILLIN CEFOTAXIME
% R
ES
IST
AN
CE
2000 2001 2000 2001
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THE PROBLEM NOW
> 50% OF HOSPITAL ACQUIRED BLOODSTREAM INFECTIONS ARE CAUSED BY METHICILLIN-RESISTANT STAPH AUREUS (MRSA)
> 70% OF NURSING HOME STAPH INFECTIONS ARE CAUSED BY MRSA
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THE PROBLEM NOW
“THERE ARE PATIENTS TODAY IN HOSPITALS FOR WHOM THERE ARE NO EFFECTIVE THERAPIES.”
Gary DoernDirector of Clinical Microbiology
University of Iowa
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NEVADANS FOR ANTIBIOTIC AWARENESS
• WHO WE ARE
• WHAT WE HAVE DONE
• WHAT WE ARE DOING
• RESULTS
• HOW CAN YOU HELP
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHO WE ARE
A STATEWIDE TASK FORCE THAT HAS BEEN IN EXISTENCE SINCE FEBRUARY 2001
3 SUBCOMMITTEES• PUBLIC AWARENESS• PROVIDER EDUCATION• INFECTION CONTROL AND SURVEILLANCE
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS• TV, RADIO SPOTS IN SPANISH AND
ENGLISH AIRING 400-500 TIMES PER MONTH
• NEVADA LEGISLATURE PASSED A BILL SUPPORTING NAA
• GOVERNOR GUINN ISSUED A PROCLAMATION SUPPORTING NAA
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS• EDUCATION PROGRAMS WERE
COMPLETED FOR ALL CLARK AND WASHOE COUNTY SCHOOL NURSES AND THEIR AIDES
• A 9TH AND 10TH GRADE SUPPLEMENTAL CURRICULUM BASED ON THE SURVIVOR SERIES IS BEING USED IN CLARK AND WASHOE COUNTIES
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS• > 10,000 BOOKMARKS HAVE BEEN
DISTRIBUTED BY THE WASHOE COUNTY LIBRARY SYSTEM
• MAJOR PHARMACY CHAINS HAVE DISTRIBUTED > 100,000 BOOKMARKS
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS• EMERGENCY ROOMS AND QUICK-CARE
CENTERS ARE DISPLAYING OUR POSTERS AND BROCHURES (SPANISH & ENGLISH)
• RECENT ANTIBIOTIC RESISTANCE INFORMATION HAS BEEN SENT TO ALL CLARK COUNTY CHILD CARE CENTERS
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PROVIDER EDUCATION• PROVIDER PACKETS WERE SENT TO ALL
PRIMARY CARE PHYSICIANS IN 2002 AND 2003
• A CME PROGRAM WAS CONDUCTED FOR > 150 PHYSICIANS IN NORTHERN NEVADA
• A HOSPITALIST EDUCATION PROGRAM HAS BEEN IMPLEMENTED IN CLARK COUNTY
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PROVIDER EDUCATION• PRESENTATIONS TO UMC SECOND-YEAR
RESIDENTS HAVE BEEN MADE• INDIVIDUAL PROVIDER OFFICE VISITS IN
ELKO AND PAHRUMP HAVE BEEN COMPLETED
• A PRESENTATION REGARDING NAA WAS MADE AT A CDC CONFERENCE
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE ARE DOING
• EXPANDING EFFORTS TO IMPROVE INFECTION CONTROL AND SURVEILLANCE WITH THE CDC 12-STEP PROGRAM
• FINISHING DEVELOPMENT OF NAA WEB SITE• DEVELOPING AND IMPLEMENTING CHILD
CARE PROFESSIONAL PROGRAM• INCREASING MEDICAL SCHOOL/RESIDENCY
INVOLVEMENT
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NEVADANS FOR ANTIBIOTIC AWARENESS
WHAT WE ARE DOING
• INCREASING PHARMACY SCHOOL INVOLVEMENT
• EXPANDING EFFORTS TO IMPROVE INFECTION CONTROL IN LONG TERM CARE AND SKILLED NURSING FACILITIES
• CONTINUING MEDIA CAMPAIGN AND ALL OTHER CURRENT EFFORTS TOWARD PUBLIC AND PROVIDER EDUCATION
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NEVADANS FOR ANTIBIOTIC AWARENESS
RESULTS
0.081 0.082 0.080
0.060
0.063
0.058 0.0560.053
0.051
0.0710.066
0.064
0.000
0.010
0.020
0.030
0.040
0.050
0.060
0.070
0.080
0.090
Quarter 1 Quarter 2 Quarter 3 Quarter 4
200020012002
Number of Antibiotic Scripts Filled per Member per Month
HPN Consolidated (Commercial and Medicare)
2000 –2002
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NEVADANS FOR ANTIBIOTIC AWARENESS
• CONTINUE WORKING WITH THE INFECTION CONTROL/SURVEILLANCE COMMITTEE
• INVITE US TO MAKE A PRESENTATION TO YOUR PHARMACY AND THERAPEUTIC COMMITTEE
• WORK WITH HEALTHINSIGHT IN OUR SURGICAL INFECTION PREVENTION PROGRAM
HOW YOU CAN HELP