Antibiotic Resistance in Bacteria: Mbbs/Bds 1 Year 27.10.2010
Antibiotic Resistance in Bacteria: Mbbs/Bds 1 Year 27.10.2010
Antibiotic Resistance in Bacteria: Mbbs/Bds 1 Year 27.10.2010
Overuse of antibiotics
Community
< Day-care centers
< Jails
Settings that Foster Drug Resistance
Hospital
< Intensive care units
< Oncology units
< Dialysis units
< Rehab units
< Transplant units
< Burn units
Antibiotic resistance in bacteria
Two types:
Intrinsic:
Naturally occuring trait
Species or genus specific
Acquired:
Acquired resistance implies that a susceptible organism has
developed resistance to an agent to which it was previously
susceptible, and can occur in two general ways: by mutation
(s) in the existing DNA of the organims or by acquisition of
new DNA.
Transposons
Mechanism of action of antibiotics
DNA gyrase DNA-directed
RNA polymerase
Quinolones
Cell wall synthesis Rifampin
ß-lactams &
Glycopeptides
(Vancomycin) DNA
THFA mRNA
Trimethoprim Protein
Ribosomes synthesis
Folic acid inhibition
synthesis DHFA 50 50 50
30 30 30 Macrolides &
Lincomycins
Sulfonamides
PABA
Protein synthesis
Protein synthesis inhibition
mistranslation Tetracyclines
Aminoglycosides
Cohen. Science 1992; 257:1064
Mechanisms of antibiotic resistance : how DO
the bacteria do it ??
Mechanisms of resistance (Contd.)
2. Alteration of Access to the target site (altered uptake or increased exit)
Involves decreasing the amt of drug that reaches the target by either:
Altering entry, for example, by decreasing the permeability of the cell wall,
Pumping the drug out of the cell (known as efflux mechanisms)
3. Enzymatic inactivation:
Mechanisms:
Altered permeability due to chromosomal mutations
Active efflux or Ribosomal protection (by
production of a protein) resulting from acquisition
of exogenous DNA
Macrolide, Lincosamide and
Streptogramin resistance:
Decreased permeability:
Quinolone resistance
Alteration of target i.e, DNA gyrase (by
mutation in gyrA gene)
Decreased permeability
Glycopeptide resistance
Alteration of target
e.g, Vancomycin resistance in Enterococci
Cotrimoxazole (Sulfonamides and
trimethoprim) resistance
Enterococci:
Penicillin resistance seen in 1983
Vancomycin resistant Enterococcus (VRE) in 1987
Even emergence of linezolid resistance
Some resistant pathogens (contd.)
Pseudomonas aeruginosa:
– One of the worrisome characteristic: low antibiotic
susceptibility
– Multidrug resistance common: due to mutation or
horizontal transfer of resitant genes
Acinetobacter baumanii
Multidrug resistance
Some isolates resistant to all drugs
Mycobacterium tuberculosis
Tests for detecting antibacterial resistance