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

1960s – METHICILLIN INTRODUCED

1991 – 29% OF STAPH AUREUS RESISTANT

2001 – 62% OF STAPH AUREUS RESISTANT

RESISTANCE

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 ANTIBIOTIC-RESISTANT 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

13 1416

18.516

2326

28

CEFTAZIDIME IMIPENEM

% R

ES

IST

AN

CE

1991 1999 2000 2001 1991 1999 2000 2001

THE PROBLEM NOW

STREPTOCOCCUS PNEUMONIA

32

42

22

29

PENICILLIN CEFOTAXIME

% R

ES

IST

AN

CE

2000 2001 2000 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 DoernDirector 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

0.081 0.082 0.080

0.060

0.063

0.058 0.0560.053

0.051

0.0710.066

0.064

0.000

0.010

0.020

0.030

0.040

0.050

0.060

0.070

0.080

0.090

Quarter 1 Quarter 2 Quarter 3 Quarter 4

200020012002

Number of Antibiotic Scripts Filled per Member per Month

HPN Consolidated (Commercial and Medicare)

2000 –2002

NEVADANS FOR ANTIBIOTIC AWARENESS

• 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

HOW YOU CAN HELP