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Description : Check out this medical titled "Antimicrobials and Antimicrobial Resistance” by Maria Clara Padoveze, Ligia Maria Abraão and Rosely Moralez de Figueiredo.

This medical is about antimicrobial and antimicrobial resistance (AMR).

Antimicrobials are substances that are used to kill or inhibit the growth of microorganisms, such as bacteria, viruses, fungi, and parasites. They are used to treat infections caused by these microorganisms, and can be administered orally, topically, or intravenously.

Antimicrobial resistance occurs when microorganisms, such as bacteria, become resistant to the antimicrobial drugs that are used to treat infections caused by them. This is a major global public health threat, as it can lead to the inability to treat infections effectively, resulting in increased morbidity and mortality rates.

AMR can occur naturally through genetic mutations or it can be acquired through exposure to antimicrobial drugs. The overuse and misuse of antimicrobial drugs in humans, animals, and agriculture have been identified as the major drivers of AMR. When antimicrobials are overused, they can select for resistant bacteria, which can then spread to other individuals, leading to the development of resistant strains of microorganisms.

To address the issue of AMR, it is important to use antimicrobials judiciously and appropriately, following established guidelines for their use. This includes avoiding the unnecessary use of antibiotics for viral infections, using the right antibiotic for the specific infection, and completing the full course of antibiotics as prescribed by a healthcare provider.

Additionally, public health measures such as infection prevention and control, vaccination, and surveillance of resistant strains of microorganisms are important in reducing the burden of AMR. Research and development of new antimicrobial drugs and alternative therapies are also critical in the fight against AMR.

Tags : Antimicrobials, Antimicrobial Resistance, microorganisms, bacteria, viruses, fungi, parasites, Infectious Disease, Infectious Disease

Published on : Jun 01, 2023 | Views : 630 | Downloads : 0

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Slide 1-

Antimicrobial Stewardship for Nursing Practice Edited by Molly Courtenay and Enrique Castro-Sánchez
Slide 2-

Chapter 3 Antimicrobials and Antimicrobial Resistance Maria Clara Padoveze, Ligia Maria Abraão and Rosely Moralez de Figueiredo
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Understand the core knowledge underpinning the concept of antimicrobial resistance Apply this knowledge to nursing practice to prevent antimicrobial resistance
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SECTION 1: Introduction
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Antimicrobials: treatment of infections reduce mortality increase life expectancy Multidrug resistant bacteria: limitations for therapeutic options
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Human contribution factors to antimicrobial resistance as public health problem Overuse of antibiotics in: Medicine Livestock farming Agriculture Poultry production Lack of development of new antibiotics
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SECTION 2: Infection
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Balance between host response and micro-organisms’ mechanisms to overcome them Infection Infection
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Colonization: process by which micro-organisms are present in the host,with a certain level of multiplication, but without producing clinical disease. Infection: involves the invasion of micro-organisms in the host’s body tissues, with the generation of an inflamatory and immunological response, leading to clinical disease and resulting in signs and symptoms. Colonization versus Infection
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Not all colonization results in infection Colonization => temporarily or permanently colonized OR development of infection Colonization is a complex process: Sometimes involves changes in the colonizing species Sometimes quick progress to infection Signs and symptoms of infection
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Important: awareness to identify early signs and symptoms of infection Nurses: have a pivotal role in the early identification of infection Clinical presentation: may be restricted to certain anatomical site (local infection) OR general signs (indicate system infection) Signs and symptoms of infection
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Signs and symptoms of infection
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Opportunities for nurse to contribute to early identification of infection (examples): Measurement of vital signs Physical examination Administration of medication: observation of catheter site Wound care: observation of characteristics of secretion or necrosis Bathing patients: observation of erythema, heat or macules and papules in the skin Emptying a urinary catheter bag: observation of changes in urine characteristics. Signs and symptoms of infection
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Importance of adequate specimen collection during relevant stages of infection Ideally before antibiotics administration The optimal time for specimen collection varies according to the type of infection Early stages of an infection is more profitable Correlate the signs and symptoms of infection and the optimal time for specimen collection. Adequate conservation of samples and timely delivery to laboratory Specimen collection
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SECTION 3: How Antimicrobials work
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Antimicrobial: includes any agente (such as antibiotics, antivirals, antifungals, and antimalarials) capable to perform against micro-organisms Produced biologically by micro-organisms or synthetically by chemists. Kill micro-organisms: (-cidal) Inhibit grow of micro-organims (-static) Antibiotic: is a type of antimicrobial substance active against bacteria Main concepts
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Broad-spectrum drug: has activity against gram-positive as well gram-negatives species Narrow-spectrum drug: has activity against only one group of micro-organisms or only one species. Therapeutic index: refers to the level of selective toxicity of a given drug comparing to the blood concentration at which a drug causes a therapeutic effect to the amount of toxicity produced in humans. Main concepts
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Classification of antimicrobials
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May vary according to: The targeted micro-organisms: antibiotics, antivirals, antifungals, antimalarials Their molecular structure Their antimicrobial mechanisms Obs.: the examples showed in the following tables are not exhaustive Classification of antimicrobials
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Target the bacterial cell wall Interfer with the building of the peptidoglican chain Interact with proteins to the synthesis of peptidoglycan chain Lysis of bacteria occurs due to disruption of the peptidoglycan layer Inhibitors of cell wall synthesis
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Inhibitors of cell wall synthesis
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Affinity for lipids bind irreversibly to cytoplasmic membrane sterols Interfere with lipid byosynthesis Lead to alterations in permeability, resulting in loss of nutrientes and other essential compounds Inhibitors of cytoplasmic membrane function
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Inhibitors of cytoplasmic membrane function * antifungals
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Binding ribosomes Cause misreading of messenger RNA, resulting in abnormal proteins or impairment of proteins synthesis Abnormal proteins will produce pores that enable more antibiotic to enter the bacterial cell Inhibitors of protein synthesis
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Inhibitors of protein synthesis
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Disrupture of DNA synthesis causing lethal DNA breaks during the replication process Several mechanisms: Binding to a subunit of RNA polymerase Inhibition of topoisomerases Phosphorylation of componentes Inhibition of viral primary transcription process Inhibiton of viral replication process Blocking the pathway for folic acid synthesis Inhibitors of nucleic acid synthesis
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Inhibitors of nucleic acid synthesis ** antivirals
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Compounds structurally similar to normal cellular metabolites Compete with cellular metabolites for attachment to enzymes Similarity of structural analogue of para-aminobenzoic acid, pteridine, nicotinamide Binding and inhibition of Beta-lactamase ring Antimetabolites
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Antimetabolites
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SECTION 4: Appropriate antimicrobial use
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To impair the action of antimicrobials: Reduction of bacterial membrane permeability Increases in expression and activity of efflux pump systems Synthesis of enzymes able to destroy or modify the drug Modification, substitution or disruption of antibiotic bacterial targets Biofilm formation Mechanisms of resistance
Slide 34-

Bacterial cellular membrane: intrinsic permeability that allows nutrients intake acts as a first barrier to external agents Low permeability on the cell surface: antibiotic blocking => drugs cannot achieve their targets a) Reduction of bacterial membrane permeability
Slide 35-

Enzymes can degrade and modify antibiotics Enzymes can degrade different antibiotics belonging to the same class: Examples: beta-lactamases: destroy beta-lactams (penicillin, cephalosporins, clavams, and monobactams) carbapenemases: destroy carbapenems b) Synthesis of enzymes to destroy a drug
Slide 36-

Very frequent mechanism Antibiotics bind to the bacterial target in a specific way, preventing their normal role Example: penicillin = bind to penicillin binding protein (PBP) = rupture of cell wall Small mutations on these targets = prevent antibiotic binding Example: altered PBP (PBPa) will not bind to penicillin c) Modification of antibiotic targets penicillin Bacterial cel penicillin Bacterial cel
Slide 37-

Efflux pump: proteins that constitutes all bacterial plasma membrane mechanism that actively transport antibiotics out of the bacterial cells Over expression of these proteins: increase expression and activity of efflux pump system d) Increases in expression and activity of efflux pump
Slide 38-

SECTION 5: Implications for nursing practice
Slide 39-

Nurses should recognize: the mechanisms that lead to antimicrobial resistance selective pressure exerted by antimicrobials how antimicrobials work Nurses: pro-active attitude regarding antibiotic therapy Implications for nursing practice
Slide 40-

Obtain allergy history from the patient to support optimal prescribing of antimicrobials Proper choice of catheter according to the therapy and clinical conditions of the patient Monitor adverse events of antimicrobial therapy Review daily condition of patients Actively take part in multidisciplinar team discusssions regarding antibiotic treatment, indication and duration Implications for nursing practice
Slide 41-

Proper and timely specimens collection Avoid unnecessary specimens collection Example: avoid urine collection of asymptomatic patients to prevent unnecessary treatment Timely examination of antibiograms to support therapy adjustment and de-escalation Implications for nursing practice
Slide 42-

Awareness: antimicrobials with restricted indication and the need to save them for specific purposes Example: isoniazid and rifampicin limited to therapy as part of treatment of mycobacterial diseases including tyberculosis. One Health approach: Multiple sectors working together to achieve better public outcomes Role of nurses
Slide 43-

Nurses are frontline professionals engaged in the fight against antimicrobial resistance
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Thank You