Professional Documents
Culture Documents
Learning Objectives
Review bacterial cell components Describe antibiotic classes Develop a thinking process to approach any infectious disease
DISCLAIMER! This presentation does NOT go into significant detail about individual antibiotic classes (please see my website: abx4dummies.weebly.com for spectrum of activity). Rather, this presentation intends to promote a thought process to help pick the right drug for the right bug!
1. Funahara, Y., Nikaido, H., 1980. Asymmetric localization of lipopolysaccharides on the outer membrane of Salmonella typhimurium. J. Bacteriol. 141, 14631465. 2. Nikaido, H., 2003. Molecular basis of bacterial outer membrane permeability revisited. Microbiol. Mol. Biol. Rev. 67, 593656.
Gram-Positive Bacteria
Gram-Negative Bacteria
Case scenario: You are the new infectious disease (ID) pharmacy student at a local hospital. The pharmacy manager hands you the morning microbiology results (see next slide). The pharmacy manager wants to know
Whats the difference between gram-positive and gramnegative bacteria? This bacteria used to be susceptible to ceftriaxone, but its resistant now. Generally speaking, what can bacteria do to become resistant to antibiotics?
Simplified approach to ID
1. Is there an infection?
Laboratory Findings
Cultures from blood, wound, urine, catheter tips, etc
For each type of infection, there are commonly associated bacteria that are responsible for the majority of the cases
Community Acquired Pneumonia
Presumptive Pathogens2
Outpatient
Never forget to think of the bug before thinking about the drug
Example: Based on what you know from IPFC and/or COOP, does the ciprofloxacin susceptibility seem a little off to you?
Case scenario: You survived your first month of COOP as an ID pharmacy student! Now youre doing a one week rotation with the ID pharmacist. Youre assigned to follow a patient with a positive Clostridium Difficle result. Take a look at the microbiology results and medication history. Does this patient actually have a C. Difficle infection?
Its easy to treat a culture, but harder to find a source of infection Infections usually occur because of physical and/or immunological compromise No point in treating an infection if circumstances allow it to come back!
Source control
all physical measures undertaken to eliminate a
source of infection, to control ongoing contamination, and to restore premorbid anatomy and function
Examples:
Drainage Debridement/ Device removal Decompression Restoration of anatomy/function
How do you pick the right drug for the right bug?
Pharmacodynamics (PD)
Bactericidal? Bacteriostatic?
Bottom line: Guidelines are a good starting point, but they are not always the answer!
Pharmacokinetics (PK)
Relates to ADME parameters to antibiotic concentration in serum and tissues Dose-adjustments
Pharmacodynamics (PD)
Antibiotic and microorganism
Case scenario: Your preceptor (MS) wants to know that youve been keeping up with your readings. Youre told that a presumptive meningitis patient (20 month old) is treated with piperacillintazobactam. MS wants to know whats wrong with this statement. Whats your thinking process to answer this question?
For each type of infection, there are commonly associated bacteria that are responsible for the majority of the cases
Meningitis Presumptive Pathogens11
Streptococcus agalactiae Streptococcus pneumoniae Neisseria meningtidis Listeria monocytogenes Haemophilus influenzae Escherichia coli
Piperacillin-Tazobactam
Covers Streptococcus agalactiae, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli
Piperacillin-Tazobactam
Covers Streptococcus agalactiae, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli
Pharmacokinetics
Distribution DOES NOT CROSS BLOOD BRAIN BARRIER
Ask the right questions about the antibiotics Antimicrobial Stewardship principles are important because the bugs are changing!
References
1. Wright GD. Q&A: antibiotic resistance: where does it come from and what can we do about it? BMC Biol 2010; 8:123. 2. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Disease Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44:S27-72. 3. Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennetts principles and practice of infectious diseases. 9th ed. Philadelphia: Churchill Livingstone/Elsevier; 2009. 4. Gilbert DN, Moellering RC, Eliopoulos GM, et al. The sanford guide to antimicrobial therapy. 42nd ed. Sperryville: Antimicrobial Therapy; 2012. 5. Anti-infective Review Panel. Anti-infective guidelines for community-acquired infections. Toronto: MUMS Guideline Clearinghouse; 2012. 6. De Waele JJ. Early source control in sepsis. Langenbecks Arch Surg 2010; 395:489-494. 7. Khan AR, Khan S, Zimmerman V, et al. Quality and strength of evidence of the Infectious Diseases Society of America clinical practice guidelines. Clin Infect Dis 2010; 51(10):1147-56. 8. Van Bambeke F, Barcia-Macay M, Lemaire S, et al. Cellular pharmacodynamics and pharmacokinetics of antibiotics: current views and perspectives. Curr Opin Drug Discov Devel 2006; 9(2):218-30. 9. Roberts JA, Lipman J. Pharmacokinetics issues for antibiotics in the critically ill patient. Crit Care Med. 2009; 37:840-851. 10.Pankey GA, Sabath LD. Clinical relevance of bacteriostatic versus bactericidal mechanisms of action in the treatment of gram-positive bacterial infections. Clin Infect Dis 2004; 38:864-70. 11. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267-84. 12.Dresser L. Practice spotlight: pharmacists in an antimicrobial stewardship program. Can J Hosp Pharm 2010; 63(4):328-329.
abx4dummies.weebly.com
What am I? Hint 1: Gram-positive cocci in groups Hint 2: -lactam antibiotics are no match for me!
Questions?