Zoonotic2- Antimicrobial Resistance

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  1. Why is antibiotic resistance becoming such a problem recently? (3)
    antibiotic development is dwindling, frequency of infection is increasing, etiologic agents have potential to become widespread
  2. High-consequence antibiotic-resistant threat because of significant risks identified across several criteria; not currently widespread but have the potential to become so.
    hazard level urgent
  3. Significant antibiotic-resistant threats; threats may worsen without ongoing public health monitoring and prevention.
    hazard level serious
  4. How do companion animals play a role in antibiotic resistance?
    important reservoirs
  5. What are the most studied etiologic agents in companion animals? (3)
    extended spectrum beta-lactamase producting enterobacteriaceae (ESBL/Amp-C producers) (serious), carbapenem-resistent enterobacteriaceae (CRE) (urgent), MRSA/MRSP
  6. What are ESBL/AMPC/CRE?
    genes found on mobile plasmids, which confer resistance to cephalosporin antimicrobials
  7. By what modes of transmission do people get resistant infections? (2)
    previously colonized (normal flora, travel to inappropriate location (wound,UT), norml flora give resistance gene to pathogenic organism), nosocomial spread (hospitalized, spread via environment)
  8. How do we become previously colonized? (5)
    foodborne, companion animals, occupational exposure, visiting other people with infection/GI colonization, international travel
  9. Humans with pets have a higher rate of _______ colonization.
  10. Role of the hospital environment in transmission of resistant infections? (3)
    spread to other patients (nosocomial), colonize ourselves (occupational), spread to owners via their pets (public health)
  11. Solution for prevention and control of resistant infections?
    antimicrobial stewardship**
  12. What are the components of antimicrobial stewardship? (6)
    correct atb use (culture and sensitivity), appropriate dosing, client education, antimicrobial categories (first choice, reserved, restricted), surveillance, veterinarian education
  13. What types of antibiotics are "reserved"?
  14. What types of antibiotics are "restricted"?
  15. What does the anagram PROTECT stand for?
    • Practice policy
    • Reduce prophylaxis
    • Other options
    • Types of bacteria and effective drugs
    • Employ narrow spectrum
    • Culture and sensitivity
    • Treat effectively
  16. What are 3 microbes that are hazard level urgent?
    C. diff, CRE, Neisseria gonorrhoeae
  17. Bacterial mechanisms of resistance. (4)
    inactivation or modification of the antibiotic (enzymes), alteration of target binding site, prevent antibiotic accumulation (increased efflux, reduce membrane permeability), modification of the metabolic pathway
  18. Cephalosporins are __________ antimicrobials, which inhibit ___________.
    β-lactam; bacterial cell wall synthesis
  19. Veterinary formulated cephalosporin used in food animals and horses.
    Ceftiofur (Exceed)
  20. What genes/mutations confer cephalosporin resistance to bacteria? (2)
    chromosomal mutations that reduce cell membrane permeability, transferable β-lactamase genes that enzymatically inactive the drug
  21. What was the first domestically-acquired ceftriaxone-resistant microbe?
    Salmonella newport in a child: plasma-encoded AmpC β-lactamase CMY-2: conferred resistance to 1st-3rd generation cephalosporins
  22. What does the CMY-2 gene confer resistance to?
    1st, 2nd, and 3rd generation cephalosporins
  23. What is the CMY-2 gene?
    plasmid encoded AmpC β-lactamase
  24. What is the CTX-M gene?
    plasmid-encoded β-lactamase in gram-negatives- ESBL
  25. What resistance does the CTX-M gene confer?
    1st, 3rd, and 4th generation cephalosporins (2nd gen still susceptible)
  26. What 3 species was resistant CTX-M Salmonella recovered from in whatever study that was?
    horses, swine, turkeys
  27. What resistance does the NDM gene confer?
    all β-lactams including carbapenam, fluoroquinolones, aminoglycosides
  28. What is the NDM gene?
  29. What is the most common mechanism of carbapenam resistance in the US today?
    KPC-1 gene
  30. What is the KPC gene?
  31. What resistance does the KPC gene confer?
  32. Carbapenenase-producing organisms have not been isolated from ___________ in the U.S., but they have been isolated from ___________.
    livestock; companion animals
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Zoonotic2- Antimicrobial Resistance
vetmed zoonotic2
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