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Antimicrobial Drug Resistance (AMDR)

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INTRODUCTION



World Medical Association Statement on Resistance to Antimicrobial Drugs (2008):

“The global increase in resistance to antimicrobial drugs, including the emergence of bacterial strains resistant to all available antibacterial agents, has created a multi-faceted public health problem of crisis proportions. AMDR carries significant economic and human implications. The development of resistant microorganisms is a problem whenever antimicrobial agents are used. The increase in high-risk populations who frequently require antimicrobial therapy, including immunocompromised patients, those undergoing invasive medical interventions, those with implanted medical devices and patients with chronic debilitating diseases, has amplified the problem. The fact that certain infectious diseases have been linked to the development of chronic disease and cancer adds another dimension to the problem.”

INTRODUCTION

Activity Highlights

Microorganisms exhibiting resistance to antibiotic drugs and disinfectants were prescreened for inclusion in this self-study material. Major microorganism strains responsible for increasing global mortality and morbidity were identified and are described in this syllabus. The following infective agents are not addressed, except as indicated in parentheses.  
  • Viruses (influenza and HIV/AIDS, which increase the risk of
    secondary microbial infections, are discussed)
  • Protozoa (malaria contributes to the morbidity and mortality
    from other opportunistic infections in select countries and is
    included in this activity)
  • Protista
  • Helminthes and fungi resistant to specific drug preparations
  • Prions 

Use of consistent definitions of AMDR terms is required for improved communications among healthcare providers. Terminology used in this activity reflects, as much as possible, the International Classification of Diseases 9th Revision (ICD-9), and as applicable the ICD-10, which is to take effect in 2013. For example, the ICD-10 classification for Bacterial Agents Resistant to Antibiotics can be found in Codes U80 to U89. 

The authors selected up-to-date AMDR clinical and other epidemiological data. As with any new educational material, some errors, omissions, and inconsistencies could have been inadvertently introduced. A critical review by subject matter experts was completed before the release of these materials. We intend to update the scientific and clinical information at least quarterly and the self-assessment questions as appropriate. 

The proposed best practices and policies rely primarily on evidence-based information. Common sense and experience from clinical practice were used when sufficient scientific and/or research data were lacking. 

Images of microorganisms cited in the syllabus are taken from the CDC Public Health Image Library (PHIL) http://phil.cdc.gov/.

A glossary of select terms used in the text are included after the Appendices.

 



Limitations

Caution should be exercised when translating the information presented in this syllabus to a specific geographical or regional practice and/or prevailing socioeconomic situation.

Copyright

Materials presented in this self-assessment are for educational purposes only. They should not be copied for further distribution and are intended for personal use only. Some of the materials contained or cited in this self-assessment may be subject to copyright and should not be used without prior approval by individual authors and/or publishers.




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Table of Contents

ACTIVITY OVERVIEW
INTRODUCTION
SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
REFERENCES
APPENDICES
GLOSSARY
Test Questions
Program Evaluation
Self Assessment


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