Transcript Document

THE
ANTIBIOTIC
RESISTANCE
CRISIS
THE ANTIBIOTIC
RESISTANCE CRISIS
• HISTORY OF BACTERIA
• HISTORY OF ANTIBIOTICS
• RESISTANCE
• THE PROBLEM NOW
• NEVADANS FOR ANTIBIOTIC AWARENESS
HISTORY OF BACTERIA
BACTERIA HAVE BEEN AROUND LONGER
THAN ANY LIVING THING ON EARTH.
FOSSIL EVIDENCE DATES BACK 3.5 BILLION
YEARS.
HISTORY OF BACTERIA
EARTH AS A DAY:
5:00 AM -
BACTERIA APPEAR
10:00 PM - DINOSAURS APPEAR
11:59 PM - HUMANS APPEAR
HISTORY OF BACTERIA
REPRODUCTION
BINARY FISSION
CLONE OF
ORIGINAL WITH SAME DNA
FAST PROCESS
ONE BACTERIUM
CAN PRODUCE ONE BILLION CLONES IN
TEN HOURS
HISTORY OF BACTERIA
REPRODUCTION
MUTATION
A CHANGE, SO THAT
THE “NEW” BACTERIA IS SLIGHTLY
DIFFERENT THAN THE ORIGINAL
HISTORY OF BACTERIA
REPRODUCTION
IF THE ENVIRONMENT
IS RIGHT, THE “NEW”
BACTERIA MAY
SURVIVE BETTER AND
REPRODUCE,
PASSING ALONG THE
MUTATION
HISTORY OF ANTIBIOTICS
1928 – DR. FLEMING DISCOVERS
PENICILLIN FROM BREAD MOLD
1944 – U.S. MILITARY TAKES PENICILLIN TO
THE BATTLEFIELD
1945 – BACTERIA WITH RESISTANCE TO
PENICILLIN ISOLATED
HISTORY OF ANTIBIOTICS
RESISTANCE
1960s – METHICILLIN INTRODUCED
1991 – 29% OF STAPH AUREUS RESISTANT
2001 – 62% OF STAPH AUREUS RESISTANT
HISTORY OF ANTIBIOTICS
RESISTANCE
BACTERIA MUTATE TO PROTECT
THEMSELVES FROM ANTIBIOTICS
HISTORY OF ANTIBIOTICS
RESISTANCE
THE MUTATED BACTERIA SURVIVE
AFTER THE ANTIBIOTICS ARE GONE
HISTORY OF ANTIBIOTICS
RESISTANCE
EVENTUALLY
THERE ARE MORE
ANTIBIOTICRESISTANT
BACTERIA THAN
NON-RESISTIANT
HISTORY OF ANTIBIOTICS
RESISTANCE
THE MUTATED
BACTERIA
REPRODUCE,
PASSING ALONG
THE RESISTANCE
TO THEIR
OFFSPRING
HISTORY OF ANTIBIOTICS
RESISTANCE
BACTERIA CAN ALSO SWAP GENES,
UNDER THE RIGHT CONDITIONS, SO
DRUG-RESISTANT GERMS CAN
SHARE THEIR RESISTANCE
MECHANISMS
THE PROBLEM NOW
PSEUDOMAS AEROGINOSA
% RESISTANCE
26
28
23
13
1991
14
1999
16
18.5
2000
CEFTAZIDIME
2001
16
1991
1999
2000
2001
IMIPENEM
THE PROBLEM NOW
% RESISTANCE
STREPTOCOCCUS PNEUMONIA
42
32
29
22
2000
2001
PENICILLIN
2000
CEFOTAXIME
2001
THE PROBLEM NOW
> 50% OF HOSPITAL ACQUIRED
BLOODSTREAM INFECTIONS ARE
CAUSED BY METHICILLIN-RESISTANT
STAPH AUREUS (MRSA)
> 70% OF NURSING HOME STAPH
INFECTIONS ARE CAUSED BY MRSA
THE PROBLEM NOW
“THERE ARE
PATIENTS TODAY IN
HOSPITALS FOR
WHOM THERE ARE
NO EFFECTIVE
THERAPIES.”
Gary Doern
Director of Clinical Microbiology
University of Iowa
NEVADANS FOR
ANTIBIOTIC AWARENESS
• WHO WE ARE
• WHAT WE HAVE DONE
• WHAT WE ARE DOING
• RESULTS
• HOW CAN YOU HELP
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHO WE ARE
A STATEWIDE TASK FORCE THAT HAS BEEN
IN EXISTENCE SINCE FEBRUARY 2001
3 SUBCOMMITTEES
• PUBLIC AWARENESS
• PROVIDER EDUCATION
• INFECTION CONTROL AND SURVEILLANCE
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS
• TV, RADIO SPOTS IN SPANISH AND
ENGLISH AIRING 400-500 TIMES PER
MONTH
• NEVADA LEGISLATURE PASSED A BILL
SUPPORTING NAA
• GOVERNOR GUINN ISSUED A
PROCLAMATION SUPPORTING NAA
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS
• EDUCATION PROGRAMS WERE
COMPLETED FOR ALL CLARK AND
WASHOE COUNTY SCHOOL NURSES AND
THEIR AIDES
• A 9TH AND 10TH GRADE SUPPLEMENTAL
CURRICULUM BASED ON THE SURVIVOR
SERIES IS BEING USED IN CLARK AND
WASHOE COUNTIES
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS
• > 10,000 BOOKMARKS HAVE BEEN
DISTRIBUTED BY THE WASHOE COUNTY
LIBRARY SYSTEM
• MAJOR PHARMACY CHAINS HAVE
DISTRIBUTED > 100,000 BOOKMARKS
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PUBLIC AWARENESS
• EMERGENCY ROOMS AND QUICK-CARE
CENTERS ARE DISPLAYING OUR POSTERS
AND BROCHURES (SPANISH & ENGLISH)
• RECENT ANTIBIOTIC RESISTANCE
INFORMATION HAS BEEN SENT TO ALL
CLARK COUNTY CHILD CARE CENTERS
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PROVIDER EDUCATION
• PROVIDER PACKETS WERE SENT TO ALL
PRIMARY CARE PHYSICIANS IN 2002 AND
2003
• A CME PROGRAM WAS CONDUCTED FOR
> 150 PHYSICIANS IN NORTHERN NEVADA
• A HOSPITALIST EDUCATION PROGRAM
HAS BEEN IMPLEMENTED IN CLARK
COUNTY
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE HAVE DONE
PROVIDER EDUCATION
• PRESENTATIONS TO UMC SECOND-YEAR
RESIDENTS HAVE BEEN MADE
• INDIVIDUAL PROVIDER OFFICE VISITS IN
ELKO AND PAHRUMP HAVE BEEN
COMPLETED
• A PRESENTATION REGARDING NAA WAS
MADE AT A CDC CONFERENCE
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE ARE DOING
• EXPANDING EFFORTS TO IMPROVE
INFECTION CONTROL AND SURVEILLANCE
WITH THE CDC 12-STEP PROGRAM
• FINISHING DEVELOPMENT OF NAA WEB SITE
• DEVELOPING AND IMPLEMENTING CHILD
CARE PROFESSIONAL PROGRAM
• INCREASING MEDICAL SCHOOL/RESIDENCY
INVOLVEMENT
NEVADANS FOR
ANTIBIOTIC AWARENESS
WHAT WE ARE DOING
• INCREASING PHARMACY SCHOOL
INVOLVEMENT
• EXPANDING EFFORTS TO IMPROVE
INFECTION CONTROL IN LONG TERM CARE
AND SKILLED NURSING FACILITIES
• CONTINUING MEDIA CAMPAIGN AND ALL
OTHER CURRENT EFFORTS TOWARD
PUBLIC AND PROVIDER EDUCATION
NEVADANS FOR
ANTIBIOTIC AWARENESS
RESULTS
Number of Antibiotic Scripts Filled per Member per Month
HPN Consolidated (Commercial and Medicare)
2000 –2002
0.090 0.081 0.082
0.080
0.080
0.070
2000
2001
0.071
2002
0.066
0.064
0.063
0.060
0.058
0.060
0.056
0.053
0.051
0.050
0.040
0.030
0.020
0.010
0.000
Quarter 1
Quarter 2
Quarter 3
Quarter 4
NEVADANS FOR
ANTIBIOTIC AWARENESS
HOW YOU CAN HELP
• CONTINUE WORKING WITH THE
INFECTION CONTROL/SURVEILLANCE
COMMITTEE
• INVITE US TO MAKE A PRESENTATION TO
YOUR PHARMACY AND THERAPEUTIC
COMMITTEE
• WORK WITH HEALTHINSIGHT IN OUR
SURGICAL INFECTION PREVENTION
PROGRAM