Professional Documents
Culture Documents
Rao MD
Dr.T.V.Rao MD 1
Discovery Of Penicillin changes the
History of Medicine
Dr.T.V.Rao MD 2
Why we Need Antibiotics
Nearly One half of the Hospitalized patients
receive antimicrobial agents.
Dr.T.V.Rao MD 3
What went wrong with
Antibiotic Usage
Treating trivial infections / viral Infections with
Antibiotics has become routine affair.
Many use Antibiotics without knowing the Basic
principles of Antibiotic therapy.
Many Medical practioners are under pressure for short
term solutions.
Commercial interests of Pharmaceutical industry pushing
the Antibiotics, more so Broad spectrum and Newer
Generation antibiotics. as every Industry has become
profit oriented.
Gram negative
Anaerobes
Atypical
Dr.T.V.Rao MD 7
Generally. Infecting Microbes..
Gram -ve
GI-tract, GU &
Anaerobes Respiratory
Mouth, teeth,
throat, sinuses &
lower bowel Peritonitis
Biliary infection
Pancreatitis
Dental infection UTI
Peritonitis PID
Appendicitis CAP/HAP/VAP
Abscesses Sinusitis
Gram +ve
Skin, Bone & Atypicals
Respiratory Chest and genito-
Cellulitis urinary
Wound infection Pneumonia
Line infection Urethritis
Osteomyelitis PID
Pneumonia Dr.T.V.Rao MD 8
Sinusitis
Why inappropriate use
of antibiotics
contributes to
antibiotic resistance
– the “why”
Dr.T.V.Rao MD 9
In-patients are at high risk of
antibiotic-resistant infections
Misuse of antibiotics in hospitals is one of
the main factors that drive development of
antibiotic resistance.
Patients in hospitals have a high
probability of receiving an antibiotic and
50% [adapt to national figure where
available] of all antibiotic use in hospitals
can be inappropriate.
Dr.T.V.Rao MD 10
Misuse of Antibiotics Drives
Antibiotic Resistance
Studies prove that misuse of antibiotics may cause
patients to become colonized or infected with antibiotic-
resistant bacteria, such as methicillin-resistant
Staphylococcus aureus (MRSA), vancomycin-resistant
enterococci (VRE) and highly-resistant Gram-negative
bacilli.13-14
Misuse of antibiotics is also associated with an increased
incidence of Clostridium difficile infections.15-17
Dr.T.V.Rao MD 11
Basis of Antibiotic Resistance
The antibiotic resistance is guided by Genomic
changes
Spread of R plasmids among the Bacteria
Do remember Antibiotics are used in Animal
husbandry apart from Medical use
The discovery of antibiotic resistance was discovered
with spread of R plasmids from animal sources
The Human gut forms the interconnecting area in R
plasmids transmission leading ultimately to
antibiotic resistance
Dr.T.V.Rao MD 12
Plasmids played a Major Role in
spread of Antibiotic resistance.
Dr.T.V.Rao MD 13
Multiple Mechanism of Drug
Resistance
Dr.T.V.Rao MD 14
Spread of Antibiotic Resistance
Indiscrimate use of
Antibiotics in Animals and
Medical practice
R plasmids spread among co-
inhabiting Bacterial flora in
Animals ( in gut )
R plasmids may be mainly
evolved in Animals spread to
Human commensal, -
Escherichia coli followed by
spread to more important
human pathogens Eg
Shigella spp.
Dr.T.V.Rao MD 15
Why Everyone worried about
Antibiotic ( misuse ) Use.
Drug resistance can reverse Medical progress
1. Tuberculosis
2. Malaria
3. Sore throat and Ear Infections.
Dr.T.V.Rao MD 16
What is Misuse of
Antibiotics?
Misuse of antibiotics can include any of the following
Dr.T.V.Rao MD 17
Dr.T.V.Rao MD 18
Aim of Antibiotic Policy
Reduce the Antimicrobial resistance
Initiate best efforts in the hospital area as many
resistance Bacteria are generated in Hospital areas
and in particular critical care areas.
Initiate good hygienic practices so these bacteria do
not spread to others
Practice best efforts, these resistance strains do not
spill into critically ill patients in the Hospital
To prevent spill into Society, as they present as
community associated infections..
Dr.T.V.Rao MD 19
Objectives of Antibiotic Policy.
Antibiotics should not be used casually
Policy emphasizes, avoiding the use of powerful
Antibiotics in the Initial treatments.
We should create awareness that we are sparing
the powerful Broad spectrum Drugs for later
treatment
Dr.T.V.Rao MD 22
Antibiotic working Group
Monitors
Formulate Optimal guidelines in
Treatment of Infections with minimal risk
of Health care associated Infections.
Dr.T.V.Rao MD 23
Education On Antibiotic policy
Acton plan for Education to all concerned
clinical staff on Antibiotic prescriptions.
Evaluate the feed back of success and failures
of the policy.
Create Infection surveillance Data
Developing facilities in Microbiology
departments for auditing data and guidance
Restrictions in prescribing and Antibiotic
availability.
A continuous education to Junior Doctors
Dr.T.V.Rao MD 24
Ideal Sample Collection is
Essential Requirement
Proper specimen collection is combined
responsibility of Clinical and Microbiological
Departments.
Continuous training of junior staff on sample
collection, and is most neglected necessity
A good clinical history is greatly helpful in
differentiating community acquired infections
from hospital acquired infections.
Dr.T.V.Rao MD 25
Pitfalls in Specimen
collection
A proper specimen
collection is most
neglected area of
Microbiology.
Scientific approaches in
Sample collection is
concern for successful
Microbiological
evaluations,
Dr.T.V.Rao MD 26
Microbiology Services
Constant up graduation
of Microbiology
departments is good
investment.
Quality control
methods in testing of
antibiotic resistance
pattern is a top priority.
Dr.T.V.Rao MD 27
Role of Microbiology
Department
Microbiology departments
asses trends in
development of
antimicrobial resistance.
The results of
sensitivity/resistance
patterns should be
correlated with
Antimicrobial agents
currently used in the
Hospital.
Identify and forecast that
nature of relation between
antibiotic use and
resistance.
Dr.T.V.Rao MD 28
Better services from
Microbiology Departments.
Basic infrastructure should
be updated for detection of
MRSA and ESBL
producers.
Documentation of all
Opportunistic infections.
and Hospital infection
outbreaks
Dr.T.V.Rao MD 29
Measures that can decrease
antibiotic resistance
Measures that guide antibiotic prescribing are likely to decrease
antibiotic resistance in hospitals.32-34 Such measures include:
Obtaining cultures
Take appropriate and early cultures before initiating empiric
antibiotic therapy,
and streamline antibiotic treatment based on the culture results35
Dr.T.V.Rao MD 30
PRIORITY ANTIBIOTIC-RESISTANT
BACTERIA PATHOGENS
The ESKAPE Pathogens: The so-called ESKAPE
Pathogens (Enterococcus faecium, Staphylococcus aureus,
Klebsiella pneumoniae, Acinetobacter baumannii,
Pseudomonas aeruginosa, and ESBL positive bacteria,
such as E. coli and Enterobacter species) represent a
grouping of antibiotic-resistant gram-positive and gram-
negative bacteria that cause the majority of U.S. HAIs.
The group is so-named because these bacteria effectively
“escape” the effects of most approved antibacterial drugs.
Dr.T.V.Rao MD 31
Advantages of
Antibiotic
Policy
Saves the Lives
Reduces the morbidity
Saves Health related
costs
Reduces the Antibiotic
related toxicity.
Patients are satisfied.
Dr.T.V.Rao MD 32
Staff Education on Antibiotic
Policy
Staff education is most Important principle in
success
Draw your own plans according to nature of
patients, your past experiences
Induction training for new staff
Continuing Medical Education to both Junior and
Senior Doctors
Include nursing staff, pharmacists for the success
of the Programme
Dr.T.V.Rao MD 33
Training in rational prescribing hasAchievements
Problem-based
pharmacotherapy
In 18 languages
For medical students,
clinical officers
Measurable improvement in
prescribing
Now also: Teacher’s Guide to
Good Prescribing
Dr.T.V.Rao MD 34
Patient Education on Antibiotic
Policy
Education of the patients and society is important
in Developing world.
Educate the patients many infections are trival,viral,
Do not need Antibiotics
If they understand Unnecessary consumption of
Antibiotics kills the Normal flora, and reduces
the Immunity and makes them potential victims
in future.
A difficult task in Developing countries.
Dr.T.V.Rao MD 35
Proved success of Antibiotic
Policies
Studies Prove
1 Rapid reversal of major clinical problems of resistance
to Chloramphenicol ,Erythromycin, and Tetracycline in
Staphylococcus aureus on withdrawal of antibiotics.
2 Out breaks of Erythromycin resistant Group A
Streptococci and Penicillin resistant Pneumococci, can
be controlled by major reduction in prescription of
Erythromycin and Penicillin.
3 Control of multiple resistant Gram – ve bacteria
rd
and
role played by reducing the prescription of 3
.
generation of Cephalosporins
( I.M.Gould Review of the role of antibiotic policies in the control of antibiotic resistance,
Journal of Antimicrobial Chemotherapy 1999 43, 459 – 465. )
Dr.T.V.Rao MD 36
Make your conclusions and
contribute to Antibiotic Policy
It is true to say that there is no absolute proof of
causative association between antibiotic use and
resistance, But many authorities believe the
association to be virtually certain.
It is pragmatic and essential approach to control
of antibiotic resistance with control of antibiotic
use.
Dr.T.V.Rao MD 37
Antibiotic resistance –
a problem in the present and the
future
Antibiotic resistance is
an increasingly
serious public health
problem: resistant
bacteria have become
an everyday concern
in hospitals across
World
Dr.T.V.Rao MD 38
CDC reports
CDC reports that
nearly 2 million health
care-associated
infections (HAIs) and
90,000 HAI-related
deaths occur annually
in the U.S. Many of
these infections and
deaths are caused by
antibiotic-resistant
infections.
Dr.T.V.Rao MD 39
New Innovations in
Diagnostic Microbiology
New rapid diagnostic tests
would greatly facilitate clinical
trials of critically needed new
antibiotics. The tests would
enable investigators to identify
potential study subjects more
easily, which would permit
smaller and less expensive
studies of antibiotics as they
move through development
Dr.T.V.Rao MD 40
Infection Control Team
Leadership and
dedicated staff;
training and
education;
mechanisms that
serve to improve
antibiotic resistance
Dr.T.V.Rao MD 41
Best way to keep the matters in
Order
Every Hospital should have a policy which is
practicable to their circumstances.
Dr.T.V.Rao MD 42
Prudent prescribing to reduce
antimicrobial resistance
• Only use an antimicrobial when clearly indicated.
Dr.T.V.Rao MD 43
Multifaceted strategies can address and
decrease antibiotic resistance in
hospitals
Antibiotic prescribing practices and decreasing antibiotic
resistance can be addressed through multifaceted
strategies including:29-31
Dr.T.V.Rao MD 44
Continuous Medical
Education a Must ..
Training and educating health care professionals on the
appropriate use of antibiotics must include appropriate
selection, dosing, route, and duration of antibiotic
therapy. To ensure that training and education is working,
there should be extensive collaboration between the
antibiotic stewardship and hospital infection prevention
and control teams. Without benchmarks, it is difficult to
track successes and weaknesses
Dr.T.V.Rao MD 45
Computerized Decisions a
Emerging Need …..
Computerized decision
support can preserve
physician autonomy and has
been shown to improve
antibiotic use by a number
of different measures: fewer
susceptibility mismatches,
allergic reactions and other
adverse events, excess
dosages, and overall amount
and cost of antibiotic
therapy
Dr.T.V.Rao MD 46
Implementation of WHONET CAN
HELP TO MONITOR RESISTANCE
Legacy computer systems,
quality improvement teams,
and strategies for optimizing
antibiotic use have the
potential to stabilize
resistance and reduce costs
by encouraging
heterogeneous prescribing
patterns and use of local
susceptibility patterns to
inform empiric treatment.
Dr.T.V.Rao MD 47
Hand Washing Reduces the Spread
of Antibiotic Resistant Strains
Dr.T.V.Rao MD 48
The Programme created by
Dr.T.V.Rao MD for ‘e’ Learning
resources for Medical Professionals in
Developing World.
Email
doctortvrao@gmail.com
Dr.T.V.Rao MD 49