Multidrug-Resistant &

Extensively-Drug
Resistant Organisms

G.VANITHA
Antimicrobial resistance
Antibiotics are a class of drugs that treat bacterial
infections by stopping growth of bacteria or killing
the bacteria directly
Antimicrobial resistance (AMR) is resistance of a
microorganism to an antimicrobial drug that was
originally effective for treatment of infections caused
by it.
Emergence of resistance to multiple antimicrobial
agents in pathogenic bacteria has become a
significant public health
Antibiotic resistance is the ability of a
microorganism to withstand the effects of an
antibiotic.
It is a specific type of drug resistance.
Antibiotic resistance evolves selective pressure,
mutation, gene transfer, inappropriate drug use,
inadequate diagnostics, hospital use and
agricultural use of drugs.
Once such a gene is generated, bacteria can then
transfer the genetic information in a horizontal
fashion (between individuals) by plasmid
exchange.
How do bacteria become resistant to
an antibiotic

Resistance happen when an infection is treated with

antibiotics but all the bacteria are not killed the ones
that remain learn how to outlive that antibiotic and are
now resistant
Not finishing the whole prescription
Not taking the proper dosage or at the proper times
Taking someone elses prescription
Taking antibiotics when not needed
 MDR
MDR is defined as non-susceptibility to at least one
agent in three or more antimicrobial categories.
Bacteria that resist treatment with more than one
antibiotic are called multidrug-resistant organisms
Multidrug-resistant organisms are found mainly in
hospitals and long-term care facilities.
They often affect people who are older or very ill and
can cause bad infections
Penicillin resistance in Staphylococcus aureus, a
common type of bacteria, was first found in the 1940s.
The more often the antibiotics are used, the more
likely it is that resistant bacteria will develop.
Hey kid wana be a MDR? Stick some of
this into your genome
Even Penicillin wont be able to harm
you.
 Common multi-drug-resistant
organisms (MDROs)
MDROs are microorganisms, predominantly bacteria, that are
resistant to one or more classes of antimicrobial agents
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-intermediate Staphylococcus aureus (VISA)
Vancomycin-resistant Staphylococcus aureus (VRSA)
Vancomycin-resistant enterococcus (VRE)
Streptococcus pneumoniae resistant to penicillin and
other broad-spectrum agents
MDR-TB
(ESBLs) producing Gram-negative bacteria
 VRE

MRSA

Gram-negative bacilli
Every year, over 2 million people in the United States
become infected with bacteria that are resistant to
antibiotics, and around 23,000 people die as a result of
these infections (CDC, 2013a).
Multidrug-resistant organisms, are bacteria that are
resistant to current antibiotic therapy and, therefore,
difficult to treat.
MDROs can cause serious local and systemic
infections that can be severely debilitating and even life-
threatening.
In the past, these infections were usually controlled by
penicillin.
The most serious concern with antibiotic resistance
is that some bacteria have become resistant to
almost all of the easily available antibiotics.
For example, Staphylococcus aureus (golden
staph) and Neisseria gonorrhoeae (the cause of
gonorrhoea) are now almost always resistant to
benzyl penicillin.
These bacteria are able to cause serious disease
and this is a major public health problem.
Methicillin-Resistant Staphylococcus
aureus
Resistant to Methicillin, Oxacillin and nafcillin
Transmitted by direct and indirect contact
more virulent than MSSA
Susceptible to common disinfectants
Staphylococcus aureus is very common, but also
very deadly if it gets into the blood stream.
It was formerly a major cause of death following
surgery.
Penicillin proved to be very effective.
When penicillin began to fail in 1950s, methicillin
proved effective.
Methicillin resistant strains were identified in 1961
but did not become common until the 1990s
(MRSA).
Vancomycin was an effective drug of last resort, but
VRSA was reported in the late 1990s.
About 2 billion people worldwide carry Staph A. and
about 50 million carry MRSA.
MRSA now accounts for more than 50% of hospital-
acquired staph infections.
According to the CDC, almost 1,00,000 cases of
invasive MRSA occurred in 2005, with 18% of these
individuals dying during their hospitalization.
These infections account for more than 5,000 deaths
each year which are directly attributable to MRSA.
Specifically, MRSA has an attributable mortality rate
of 6.9% at 30 days and 16.7% at 1 year.
The additional cost of MRSA alone is 39,000 per
case in patients with a MRSA surgical-site infection
Mortality rates were 13% higher in patients with
MRSA infection, regardless of mechanism of death.
Extended spectrum beta-lactamase
producers (ESBLs)
Gram negative organisms - Enterobacteriaceae
Excrete the enzyme beta-lactamase
Inactivates -lactam (penicillin) type antibiotics
Resistance to -lactams emerged several years ago
and has continued to rise ESBLs
Klebsiella
E. coli
Serratia
others
Beta-lactam resistance
Drug resistance facts
MRSA and VRE are terms that describe specific types
of antibacterial resistance; MRSA describes Methicillin-
Resistant Staphylococcus aureus bacteria while VRE
describes Vancomycin-Resistant Enterococi.
Drug resistance occurs when microbes survive and
grow in the presence of a drug that normally kills or
inhibits the microbe's growth.
The history of drug resistance began with the
development of antimicrobial drugs, and the
subsequent ability of microbes to adapt and develop
ways to survive in the presence of antimicrobials.
Diagnosis of antimicrobial drug resistance is
performed by lab tests that challenge the isolated
microbes to grow and survive in the presence of the
drug.
Treatment of antimicrobial drug resistance depends
on the type of infection and what the patient and
their doctor decide.
Prevention of antimicrobial drug resistance is aided
by preventing the overuse and misuse of
antimicrobials; infections can be reduced by a
healthy lifestyle, hand washing, and other good
hygiene methods
Antimicrobial resistance is a growing health issue
because more resistant microbes are being
detected and societal pressures often result in
overuse.
 XDR
XDR is defined as non-susceptibility to at least one
agent in all but two or fewer antimicrobial categories
(i.e. bacterial isolates remain susceptible to only one
or two categories).
Multidrug-resistant tuberculosis (MDRTB)
Resistance to Isoniazid and Rifampicin
Extensively (extremely) drug-resistant (XDR-TB)
MDR-TB plus resistance to a second line injectable
drug such as amykacin plus a quinolone.
MDR & XDR TB
The term XDR TB appears to have been used for the
first time in March 2006.
WHO describing strains of TB, referred to as XDR TB,
that were resistant not only to isoniazid and rifampicin
(that is they were MRD TB) but they were also resistant
to at least three of the six classes of second line anti TB
drugs.
In 1980 50% of TB bacilli were resistant to 1 drug.
Multi-drug resistant TB (MDR-TB) began to emerge.
There are now an estimated 1.5million MDR cases
worldwide.
Extreme drug resistance (XDR-TB) was reported in
2006.
The first completely drug resistant (CDR-TB) case was
reported in Italy in 2007.
MDR-TB has emerged and spread due to the
inadequacy of treatment. Today, treatment for drug-
resistant TB can take up to two years, and is so
complex, expensive, and toxic that a third of all MDR-
TB patients die.
WHO treatment standards require that at least four
drugs be used to treat TB in order to avoid the
development of further resistance.
According to the WHO, Eastern Europe's rates of MDR-
TB are the highest, where MDR-TB makes up 20% of
all new TB cases.
In some parts of the former Soviet Union, up to 28% of
new TB cases are multidrug-resistant.
Among previously treated cases in the same region,
reported rates of drug resistance are commonly
above 50% and as high as 61%.
During the late 1980s and early 1990s, outbreaks of
MDR-TB in North America and Europe killed more
than 80% of those who contracted the disease.
During a major TB outbreak in New York City in the
early 1990s, one in 10 cases proved to be drug-
resistant.
Today, drug-resistant TB is also quite common in
India and China the two countries with the highest
MDR-TB burdens.
Treatment for MDR-TB consists of what are called
second-line drugs. These drugs are administered
when first-line drugs fail.
 Treatment for MDR-TB is commonly administered for
2 years or longer and involves daily injections
for six months. Many second-line drugs are toxic and
have severe side effects.
The World Health Organization has issued a target of
treating 80% of MDR-TB cases by 2015.
The cost of curing MDR-TB can be literally thousands
of times as expensive as that of regular treatment in
some regions.
Top MDR-TB High-
Burden Countries
1. China 15. Democratic Republic of Congo
2. India 16. Ethiopia
3. Russian Federation 17. Azerbaijan
4. Pakistan 18. Tajikistan
5. South Africa 19. Republic of Moldova
6. Philippines 20. Kyrgistan
7. Nigeria 21. Belarus
8. Bangladesh 22. Georgia
9. Indonesia 23. Armenia
10.Myanmar 24. Bulgari
11.Ukraine 25. Lithuania
12.Uzbekistan 26. Latvia
13.Kazakhstan 27. Estonia
14.Viet Nam
Extensively drug-resistant TB (XDR-TB), also known
as Extremely Drug-Resistant TB, is emerging as an
even more ominous threat.
This makes XDR-TB treatment extremely complicated,
if not impossible, in resource-limited settings.
In a 2006 XDR-TB outbreak in South Africa, 52 of 53
people who contracted the disease died within months.
It is estimated that 70% of XDR-TB patients die within a
month of diagnosis.
The most recent drug-resistance surveillance data
issued by the WHO estimates that an average of
roughly 5 % of MDR-TB cases are XDR-TB.
Estimating the incidence of XDR-TB is extremely
difficult because most laboratories are ill-equipped to
detect and diagnose it; it is thought that the majority of
XDR-TB cases go undocumented.
MDR & XDR TB is not
spread by
Shaking someones hand
Sharing food or drink
Touching bed linens or toilet
seats
Sharing toothbrushes
Kissing
Smoking or sharing cigarettes
Relationship of MDR, XDR and
PDR to each other
 Prevent of MDR & XDR?
Hand Hygiene The Most Important Way to Prevent
Transmission of Microorganisms and Infection
Use the appropriate
antimicrobial for an infection;
e.g. no antibiotics for viral
infections
Identify the causative
organism whenever possible
Select an antimicrobial which
targets the specific organism,
rather than relying on a
broad-spectrum antimicrobial
Complete an appropriate
duration of antimicrobial
treatment (not too short and
not too long)
Use the correct dose for
eradication; subtherapeutic
dosing is associated with
resistance, as demonstrated in
food animals.
Minimize unnecessary
prescribing and overprescribing
of antibiotics.
REFERANCE

Centers for Disease Control www.cdc.gov

www.hain-lifescience.de
http://www.micro-blog.info/2014/04/considering
-the-burden-of-enhanced-cre-screening
/
http://www.cdc.gov/drugresistance/threat-
report-2013/.
http://
whqlibdoc.who.int/publications/2010/97892415
99191_eng.pdf
Multidrug-Resistant Organisms Ann Bailey,
Joanne Dixon
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