2.3 Mechanisms of Antibiotics Resistance

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Questions and Answers

What is the primary consequence of antibiotic resistance in patients with pneumococcal meningitis in the US?

Temporary hearing loss

Prolonged hospital stay

Increased risk of heart disease

Permanent hearing loss (correct)

What is the main reason for the increased medical costs associated with antibiotic resistance?

Longer treatment durations

Higher cost of antibiotics

Increased hospital stay

All of the above (correct)

What was the first antibiotic discovered, and when was it discovered?

Tetracycline, 1960

Penicillin, 1928 (correct)

Streptomycin, 1950

Ampicillin, 1940

What is the definition of antibiotic resistance?

The change in bacteria that reduces the effectiveness of drugs Signup and view all the answers

What is the primary concern with the overuse of broad-spectrum antibiotics?

They alter the microbial ecology of the human body Signup and view all the answers

What is the main benefit of antibiotic therapy?

Reducing the duration of illness Signup and view all the answers

What is the process by which a microorganism acquires genes from another without being the offspring of that microorganism?

Horizontal gene transfer Signup and view all the answers

What is the mechanism of gene transfer that involves transferring genes as 'naked' DNA?

Transformation Signup and view all the answers

What is the consequence of the misuse and overuse of antibiotics?

The evolution of antibiotic-resistant bacteria Signup and view all the answers

What is the primary concern with the use of newer antibiotics?

They are more expensive than older antibiotics Signup and view all the answers

What is the mechanism of antibiotic resistance in which modified antibiotics are no longer substrates for the original antibiotic-metabolizing enzyme?

Synthesis of modified antibiotics Signup and view all the answers

What is the function of the phosphotransferase enzyme in Kmr bacteria?

To phosphorylate antibiotics Signup and view all the answers

What is the main reason for antibiotics not penetrating the biofilm efficiently?

Physicochemical interactions between the drug and the matrix Signup and view all the answers

What is the result of stepwise selection processes involving multiple genetic mutations in bacteria?

Bacteria become highly resistant to specific antibiotics while maintaining a level of resistance Signup and view all the answers

What is the main issue with efflux in relation to treating infections?

It is undesirable for organisms trying to treat infections Signup and view all the answers

What is the result of the modification of UDP-N-acetylglucosamine enolpyruvyl transferase?

Altered binding site of fosfomycin Signup and view all the answers

What is the estimated cost of device-related infections in the USA per year?

Over $3 billion Signup and view all the answers

What is the mechanism of erythromycin resistance in some bacteria?

Methylation of the ribosomal target site Signup and view all the answers

How do enzymes contribute to antibiotic resistance in bacterial cells?

By modifying the structure of antibiotics, making them less effective Signup and view all the answers

What is the main reason for high antibiotic dose strategies being generally less preferred?

Increased risk of side effects and drug toxicity Signup and view all the answers

What is the main function of beta-lactamase enzymes in bacterial cells?

To break the beta-lactam ring of antibiotics Signup and view all the answers

What is the result of high-level resistance to aminoglycosides in Enterococci?

Reduced bactericidal activity Signup and view all the answers

What is the mechanism of low-level resistance to vancomycin?

Change in cell wall precursors with low affinity for vancomycin Signup and view all the answers

Why did flucloxacillin become ineffective against staphylococci?

Due to the development of a different type of penicillinase Signup and view all the answers

What is the purpose of the efflux system in bacteria?

To remove antibiotics from the cell Signup and view all the answers

What is the effect of erythromycin esterase on macrolide antibiotics?

It catalyzes the hydrolytic cleavage of the lactone ring Signup and view all the answers

What is the result of the imbalance between degraded and inactivated slow-releasing antibiotics and rapid bacterial proliferation?

Ineffective treatment of infection Signup and view all the answers

What is the role of biofilm formation in antibiotic resistance?

It reduces the susceptibility of microbes to antibiotics Signup and view all the answers

How do Mpr bacteria resist macrolide lincosamide and streptogramin B MLS antibiotics?

Through target modification Signup and view all the answers

What is the result of phenotypic changes in biofilm bacteria?

Antibiotics become less effective Signup and view all the answers

What is the main characteristic of biofilm cells that leads to antibiotic tolerance?

Close-knit pack and slow growth rate Signup and view all the answers

What is the result of the lactonization of the macrolide 2' hydroxyl group on rRNA in wild-type bacteria?

No effect on antibiotic potency Signup and view all the answers

What is the mechanism of aminoglycoside uptake inhibition in P.aeruginosa biofilms?

High-affinity mechanisms Signup and view all the answers

What is the purpose of the extracellular matrix in biofilms?

To sequester molecules, preventing them from reaching their target cells Signup and view all the answers

What type of infections are often resistant to antibiotics due to biofilm formation?

Chronic infections Signup and view all the answers

What is the effect of modified target enzymes on antibiotic-resistant bacteria?

They allow antibiotic resistant bacteria to display altered physiological and gene expression patterns Signup and view all the answers

What is the role of beta-lactamase inhibitors in antibiotic therapy?

To inhibit the production of beta-lactamase Signup and view all the answers

What is the primary function of efflux systems in bacteria?

To extrude antibiotics across cellular membranes Signup and view all the answers

Which of the following is a characteristic of the single drug/MF superfamily?

Can confer resistance to several unrelated drugs Signup and view all the answers

What is the function of the AcrAB-TolC system in E. coli?

To recognize and expel various substrates Signup and view all the answers

What is the mechanism of antibiotic resistance in MRSA isolates?

Production of an alternative PBP with low affinity for beta-lactam compounds Signup and view all the answers

What is the function of the QacA multidrug efflux pump in Staphylococcus?

To confer resistance to various organic cationic compounds Signup and view all the answers

What is the mechanism of antibiotic resistance in E. faecium?

Combination of reduced drug uptake and efflux system Signup and view all the answers

What is the function of carbapenemase enzymes in certain Enterobacteriaceae?

To directly hydrolyze carbapenems to inactive metabolites Signup and view all the answers

What is the mechanism of ribosomal protection in Bacillus?

Transfer of an ATP-binding ribosomal protein Signup and view all the answers

What is the primary function of the AcrAB system in E. coli?

To recognize and expel various substrates Signup and view all the answers

What is the characteristic of the ABC efflux system?

Uses ATP to transport specific substrates Signup and view all the answers

Which major breakthrough in human health history controls the growth of harmful bacteria?

Antibiotics Signup and view all the answers

Which type of bacteria are antibiotics effective against, especially staphylococci and streptococci?

Gram-positive bacteria Signup and view all the answers

What was the first antibiotic that was most effective against gram-positive bacteria?

Penicillin Signup and view all the answers

What has undermined the success of antibiotics, leading to a rise in antibiotic resistance among bacterial pathogens?

The evolution of antibiotic-resistant bacteria Signup and view all the answers

What is a growing concern as bacteria evolve to be resistant to antibiotics, making treatments ineffective?

Antibiotic resistance Signup and view all the answers

Which bacteria's resistance to penicillin in the 1980s exemplifies the detrimental effects of antibiotic resistance?

Streptococcus pneumoniae Signup and view all the answers

What is the primary function of efflux pumps in bacterial cells?

Transporting antibiotics out of the cell Signup and view all the answers

Which bacterial species is known for the NorA pump providing resistance to various antibiotics?

Staphylococcus aureus Signup and view all the answers

What is the function of the MtrCDE efflux pump system in Neisseria gonorrhoeae?

Removing toxic compounds from the cell Signup and view all the answers

Which of the following is not one of the described families of efflux pumps in bacteria?

MTD Signup and view all the answers

What is the energy source used by efflux pumps to transport substrates?

Proton motive force Signup and view all the answers

In the MtrCDE system of Neisseria gonorrhoeae, what is the role of the regulatory protein MtrR?

Represses the efflux pump system Signup and view all the answers

What structural components make up an efflux pump system in bacterial cells?

Cytoplasmic membrane protein, periplasmic protein, outer membrane protein Signup and view all the answers

What is the role of the adaptor protein in the RND efflux pump system?

Connects the RND pump to the outer membrane Signup and view all the answers

Which family of efflux pumps requires ATP and has distinct energy coupling domains?

ABC Signup and view all the answers

What is the main purpose of efflux pump systems in bacteria regarding toxic compounds?

To avoid inhibitory effects and maintain a less toxic intracellular environment Signup and view all the answers

How are genes transferred in transduction?

Through the action of a bacteriophage Signup and view all the answers

What is the mechanism of genetic material exchange in horizontal gene transfer involving recombination?

Formation of a bridge-like connection between cells Signup and view all the answers

What characteristic is exhibited by bacterial cells in DNA-mediated transformation?

Sharing a significant similarity with recipient chromosome Signup and view all the answers

What provides energy to efflux pump systems for expelling antibiotics from bacterial cells?

Proton motive force Signup and view all the answers

Which enzyme is produced by some bacteria to break down antibacterial drugs?

Penicillinase Signup and view all the answers

What can potentially increase the effectiveness of current and future antibiotics according to the text?

Development of efflux pump inhibitors Signup and view all the answers

How are plasmids or mobile genetic elements transferred in conjugation?

Through a pilus Signup and view all the answers

What allows bacteria to spread resistance determinants throughout a population?

Horizontal gene transfer Signup and view all the answers

Which mechanism of genetic transfer requires the DNA to share significant similarity with the recipient chromosome?

Recombination Signup and view all the answers

What is the classification for the systems that provide resistance by expelling antibiotics from cells?

Efflux pump systems Signup and view all the answers

What is the mechanism of inactivation of rifamycins and quinolones in antibiotic-resistant bacteria?

Alteration of the target site to prevent antibiotic binding Signup and view all the answers

Which of the following is a mechanism of antibiotics modification in antibiotic resistance?

Reduced accumulation of antibiotics inside the bacteria Signup and view all the answers

What is the effect of penicillinase on penicillin?

It hydrolyzes the β-lactam ring of penicillin Signup and view all the answers

Which of the following is an example of antibiotic resistance due to the alteration of the target site?

Rifamycin resistance Signup and view all the answers

What is the mechanism of tetracycline resistance in bacteria?

Active transport of tetracycline out of the bacteria Signup and view all the answers

Which of the following is a mechanism of antibiotic resistance in bacteria?

Production of specific channels that allow low molecular weight solutes to enter the bacterial cell Signup and view all the answers

What is the main reason why physicians continue to prescribe antibiotics despite knowing it's not necessary for viral infections?

To comply with patient expectations Signup and view all the answers

In which country has education campaigns and restrictions on antibiotic use for complications been effective?

Netherlands Signup and view all the answers

What percentage of hospital prescriptions are not optimally effective due to inappropriate antibiotic choice?

75% Signup and view all the answers

What is the main issue with self-medication using leftover antibiotics from previous prescriptions?

It leads to antibiotic resistance Signup and view all the answers

What is the primary concern with the use of antibiotics in animal agriculture?

It conceals poor animal husbandry and facility management practices Signup and view all the answers

What is the result of delays in prescribing antibiotics for conditions where they may be necessary?

Reduced antibiotic resistance Signup and view all the answers

What is the main reason why lower prescribing rates in health maintenance organizations do not result in more return visits or an increase in hospitalization?

Patients are less likely to expect antibiotics Signup and view all the answers

What is the estimated percentage of the population that has self-medicated with antibiotics in Macedonia?

57% Signup and view all the answers

Why do fast food chains, meat producers, and food retailers implement restrictive policies or pledges to limit or ban antibiotic use in animal agriculture?

To reduce antibiotic resistance Signup and view all the answers

What is the consequence of the misuse and overuse of antibiotics in health maintenance organizations?

Increased resistance rates and increased morbidity and mortality Signup and view all the answers

What is the primary factor contributing to the public's misuse of antibiotics?

Lack of knowledge on proper antibiotic use Signup and view all the answers

What is the consequence of patients not completing a full course of antibiotics prescribed to them?

It results in the need for different antibiotics or stronger doses Signup and view all the answers

What is the percentage of antimicrobial therapy for respiratory tract infections that may be unnecessary?

20% Signup and view all the answers

What is the primary reason for pharmaceutical companies to stop antibiotic research?

Reduced demand for newer, more potent antibiotics Signup and view all the answers

What is the role of the public in overseeing and improving the health system and policies related to antibiotic use?

To play a role in overseeing and improving the health system and policies Signup and view all the answers

What is the main factor contributing to the spread of antibiotic resistance in the health system?

Unnecessary antibiotic use Signup and view all the answers

What is the consequence of antibiotic misuse and abuse in the health system?

It contributes to antibiotic resistance Signup and view all the answers

What is the primary challenge in explaining antibiotic resistance to the public?

It is largely invisible and not always encountered in clinical situations Signup and view all the answers

What is the percentage of respondents who believe the best treatment for a cold is antibiotics?

25% Signup and view all the answers

What is the main issue with health policy and decisions related to antibiotic use?

They are not relevant to the current public's understanding of antibiotics Signup and view all the answers

What is the primary reason for the inadequacy of infection prevention and control in developing countries?

Limited resources and funding Signup and view all the answers

What is the primary consequence of poor hand hygiene in healthcare settings?

Higher risk of contracting infections Signup and view all the answers

What is the primary difference between sterilization and sanitization?

Sterilization eliminates all microbial life, while sanitization reduces microbial life to a safe level Signup and view all the answers

What is the primary reason for the failure to prevent and control infections in healthcare settings?

Inadequate infection prevention and control practices Signup and view all the answers

What is the primary consequence of the spread of antibiotic-resistant bacteria from developed to developing countries?

Higher risk of contracting infections Signup and view all the answers

What is the primary reason for the importance of hand hygiene in healthcare settings?

To prevent infection transmission Signup and view all the answers

What is the primary factor contributing to the high infection rates in developing countries?

Proximity of disease and weak immune systems Signup and view all the answers

What is the primary reason for the importance of sterilization in medical and surgical procedures?

To eliminate all microbial life Signup and view all the answers

What is the primary consequence of inadequate sanitation and hygiene practices in healthcare settings?

Higher risk of contracting infections Signup and view all the answers

What is the primary factor contributing to the spread of infectious diseases across international borders?

Poor infection prevention and control practices Signup and view all the answers

What is the primary consequence of antibiotic resistance in developing countries?

Higher disease and mortality rates Signup and view all the answers

What is the result of the transmission of resistant strains from developing countries to developed countries?

Higher antibiotic resistance rates Signup and view all the answers

Why do developing countries tend to have higher antibiotic resistance rates?

Unregulated and easily obtainable antibiotics Signup and view all the answers

What is the concern with international travel and commerce in relation to antibiotic resistance?

Increased transmission of resistant strains Signup and view all the answers

What is the result of the importation of new strains of resistant bacteria?

Increased disease outbreaks Signup and view all the answers

Why do refugees and immigrants returning to their countries of origin pose a risk of importing resistant strains?

They may have acquired infection with the organism in the Western country Signup and view all the answers

What is the consequence of the spread of diseases like tuberculosis and HIV in developing countries?

Serious effects, especially for immunocompromised patients Signup and view all the answers

What is the result of comparing antibiotic resistance in different regions?

An increased global view of antibiotic resistance Signup and view all the answers

What is the risk of international travel to developing countries with high antibiotic use rates?

Increased risk of becoming a carrier of resistant strains Signup and view all the answers

What is the consequence of antibiotic resistance in developing countries?

Increased disease prevalence Signup and view all the answers

What is the primary means of DNA transfer from a donor cell to a recipient in horizontal gene transfer?

Recombination Signup and view all the answers

What is the approach that could slow the spread of resistance, but is only a short-term solution?

Using antibiotics to which the pathogens are still sensitive Signup and view all the answers

What is the mechanism of horizontal gene transfer in which DNA is released into the environment upon cell lysis and taken up by another bacterium?

Transformation Signup and view all the answers

Why is it difficult to eradicate resistant strains of bacteria?

Because they can transfer genes between bacteria of different genera or species Signup and view all the answers

What is the primary way to break the cycle of gene transmission from harmful human bacteria to the environment?

Reducing the prevalence of resistant pathogens Signup and view all the answers

What is the result of the reintroduction of a resistant MRSA bacteria from the local community into the hospital?

The hospital strains of resistant bacteria act as continuous sources of gene transfer to the environment Signup and view all the answers

What is the primary consequence of the widespread use of antibiotics on bacterial populations?

Selection for antimicrobial resistance in pathogenic bacteria Signup and view all the answers

What is the main source of antibiotic resistant genes in soil and water?

Non-pathogenic environmental bacteria Signup and view all the answers

What is the vehicle for gene transfer between vastly different species of bacteria?

Mobile genetic elements Signup and view all the answers

What is the primary concern with the disposal of outdated or unwanted antibiotics in the UK?

Landfill and incineration Signup and view all the answers

What is the result of antibiotic discharge into water systems?

Altered bacterial populations Signup and view all the answers

What is the primary mechanism of antibiotic resistance in environmental bacteria?

Gene transfer Signup and view all the answers

What is the consequence of antibiotic resistance in the environment?

Re-emergence of resistant pathogens Signup and view all the answers

What is the main reason to block transmission of antibiotic resistance genes from known resistant pathogens?

To prevent the spread of resistant pathogens Signup and view all the answers

What is the primary source of antibiotic residues in sewage and animal manures?

Human and animal waste Signup and view all the answers

What is the consequence of antibiotic resistance in agricultural sources?

High prevalence of antibiotic resistance Signup and view all the answers

What is the primary reason why few large pharmaceutical companies are developing new antibiotics?

Because the market does not value a novel antibiotic at a price that can offset its development costs Signup and view all the answers

What is the estimated cost of developing new antibiotics?

$90 million Signup and view all the answers

Why are new antibiotics often kept as a last-line therapy?

To prevent resistance Signup and view all the answers

What is the result of the fear that newer drugs may suffer the same fate as previous drugs that lost efficacy?

Pharmaceutical companies have abandoned antibiotic research in favor of more profitable therapeutic agents Signup and view all the answers

What is the primary reason why small companies are the primary developers of new antibiotics?

Due to the limited economic return for new antibiotics Signup and view all the answers

What is the result of the increase in regulatory hurdles and toxicity risks in antibiotic research?

The cost of bringing a new drug to market and the likelihood of it being pulled from the market are similar for cytotoxic anti-cancer agents and antibiotics Signup and view all the answers

What is the primary challenge in the development of new antibiotics according to the text?

The market does not value a novel antibiotic at a price that can offset its development costs Signup and view all the answers

What is the result of the decline in profitability of antibiotic production?

Pharmaceutical investment is declining Signup and view all the answers

What is the primary reason why large pharmaceutical firms have decided that investing in novel antibiotic development is not worth the R&D cost and time to market?

Because the market does not value a novel antibiotic at a price that can offset its development costs Signup and view all the answers

What is the primary consequence of antibiotic resistance in patients with pneumococcal meningitis in the US?

The primary consequence is not mentioned in the text Signup and view all the answers

What is one of the consequences when porin proteins change and become too small for antibiotic molecules to enter?

Reduced antibiotic access to the target Signup and view all the answers

What is a common method used by bacteria to deactivate antibiotics?

Producing enzymes like beta lactamases Signup and view all the answers

What is a consequence of antibiotic misuse by pet owners?

Worsening the severity of diseases Signup and view all the answers

What is the primary concern about antibiotic resistance according to the text?

Increased economic burden on countries Signup and view all the answers

What is a factor contributing to the antibiotic resistance in animals?

Mixing antibiotics in animal food or water Signup and view all the answers

Why is antibiotic self-medication considered dangerous according to the text?

Results in development of antibiotic-resistant bacteria Signup and view all the answers

What makes antibiotic self-medication prevalent globally?

Poor awareness of antibiotic dangers Signup and view all the answers

What is a concern related to antibiotic prescriptions in the United States?

47 million unnecessary antibiotic prescriptions annually Signup and view all the answers

How does misuse of antibiotics lead to antibiotic resistance?

Can cause mutations in bacterial genes Signup and view all the answers

What is the primary issue with antibiotic resistance in animals linked to human health?

Transfer of resistant strains from animals to humans Signup and view all the answers

What is the primary challenge in obtaining a clear global picture of antibiotic resistance?

Lack of coordination in surveillance data collection Signup and view all the answers

Why is it difficult to empirically demonstrate the link between antibiotic exposure and resistance?

Antibiotic-resistant strains are often less virulent than their susceptible counterparts Signup and view all the answers

What is the primary limitation in monitoring antibiotic use in humans?

Limited knowledge about the volume and pattern of antibiotic use Signup and view all the answers

What is the consequence of incomplete reporting of antimicrobial resistance in the non-hospital sector?

Inadequate understanding of resistance patterns in the community sector Signup and view all the answers

What is the primary reason for the lack of valuable resistance pattern data in developing countries?

Poor design and execution of studies Signup and view all the answers

What is the primary challenge in monitoring resistance in the community sector?

Poorly coordinated or not enforced data collection networks Signup and view all the answers

What is the consequence of limited data on resistance patterns in the general population?

Inadequate understanding of resistance patterns in the general population Signup and view all the answers

What is the primary limitation in understanding resistance patterns in the community sector?

Complexity of resistance as a slow-developing and often asymptomatic condition Signup and view all the answers

What is the primary reason for the lack of participation of primary care physicians in reporting networks?

Greater time and resource constraints Signup and view all the answers

What is the primary consequence of limited data on antibiotic use in humans and animals?

Inadequate understanding of the link between antibiotic use and resistance Signup and view all the answers

What is the primary consequence of prolonged illness in patients with resistant infections?

Increased antibiotic consumption and transmission of resistant strains Signup and view all the answers

What is the estimated annual cost of treating resistant infections in the European Union?

€1 billion Signup and view all the answers

What is the primary goal of antibiotic stewardship programs?

To reduce the development of antibiotic resistance Signup and view all the answers

What is the consequence of the lack of effective therapy for resistant organisms?

Treatment failure and death Signup and view all the answers

What is the projected number of MRSA-attributable deaths annually in the United States by 2020?

55,000 Signup and view all the answers

What is the primary challenge in implementing antibiotic stewardship programs?

Changing prescribing practices of healthcare professionals Signup and view all the answers

What is the consequence of the rise in antibiotic resistance in the United States?

Increased healthcare costs Signup and view all the answers

What is the primary benefit of providing easier access to experts in infectious diseases?

Changing prescribing practices of healthcare professionals Signup and view all the answers

What is the estimated annual cost of antibiotic resistance in the United States?

US $4-5 billion Signup and view all the answers

What is the primary concern of antibiotic resistance in Escherichia coli?

The future of antibiotic treatment Signup and view all the answers

What is the primary consequence of antibiotic resistance on patient outcomes?

Increased treatment failure and extended hospital stays Signup and view all the answers

What is the estimated cost of treating antibiotic-resistant infections in the United States?

$3.1 billion Signup and view all the answers

What is the consequence of reducing the use of newer antibiotics in situations where their clinical advantage is marginal?

Prudent economic decision Signup and view all the answers

What is the association between higher levels of antibiotic use and bacterial resistance?

Direct Signup and view all the answers

What is the primary reason for the increased medical costs associated with antibiotic resistance?

All of the above Signup and view all the answers

What is the consequence of treatment failures due to antibiotic resistance?

Compromised natural defense mechanisms Signup and view all the answers

What is the estimated number of additional deaths that could result from antibiotic-resistant infections at an average level of antibiotic resistance?

100,000 Signup and view all the answers

What is the primary reason for the increased healthcare costs associated with antibiotic-resistant infections?

All of the above Signup and view all the answers

What is the consequence of antibiotic resistance on the healthcare system?

Significant implications for the healthcare system Signup and view all the answers

What is the estimated cost of treating a sample of resistant infections in the United States?

$11,837,000 Signup and view all the answers

What is the primary mechanism by which antibiotics exert their effect on bacterial cells?

Inhibiting the synthesis of bacterial cell walls Signup and view all the answers

What is the primary consequence of the rapid development and approval of antibiotics?

Increased antibiotic resistance due to genetic mutation Signup and view all the answers

What is the primary function of surveillance cultures in hospitals?

To detect resistant strains and prevent their spread Signup and view all the answers

What is the primary goal of developing rapid diagnostics for identifying resistant strains?

To detect resistant strains and prevent their spread Signup and view all the answers

What is the primary reason why antibiotic-resistant strains pose a significant threat to last-line antibiotics?

Due to their ability to evade antibiotic action on the cell Signup and view all the answers

What is the primary consequence of antibiotic misuse in patients?

Increased antibiotic resistance and treatment failure Signup and view all the answers

What is the primary goal of SWOT analysis in antibiotic development?

To identify factors influencing antibiotic development and reduce resistance Signup and view all the answers

What is the primary mechanism of antibiotic resistance in bacteria?

Genetic mutation and horizontal gene transfer Signup and view all the answers

What is the primary benefit of developing new antibiotics?

Reduced antibiotic resistance and improved treatment outcomes Signup and view all the answers

What is the primary consequence of the spread of antibiotic-resistant strains?

Increased treatment failure and serious complications Signup and view all the answers

What is the primary reason for the increased morbidity and mortality due to antibiotic resistance?

Increased use of broad-spectrum antibiotics Signup and view all the answers

What is the estimated percentage of antibiotics prescribed that are unnecessary or inappropriate?

50% Signup and view all the answers

What is the primary consequence of antibiotic resistance in public health?

All of the above Signup and view all the answers

What is the primary reason for the overuse of antibiotics in hospital-acquired infections?

Fear of legal repercussions Signup and view all the answers

What is the primary concern with the use of broad-spectrum antibiotics?

All of the above Signup and view all the answers

What is the primary reason for the reduced effectiveness of antibiotics in treating infections?

Overuse and misuse of antibiotics Signup and view all the answers

What is the primary characteristic of hospital-acquired infections that contributes to antibiotic overuse?

They are more severe Signup and view all the answers

What is the primary consequence of antibiotic resistance in individual patients?

All of the above Signup and view all the answers

What is the primary consequence of the widespread use of antibiotics over the past 60 years?

The overuse and misuse of antibiotics, leading to genetic selection in favor of resistant bacteria Signup and view all the answers

What is the primary reason for the widespread use of broad-spectrum antibiotics in the United States?

Belief that newer generation drugs are better Signup and view all the answers

What is the primary cause of antibiotic resistance in bacteria?

Natural response to antibiotic effects Signup and view all the answers

What is the main implication of antibiotic resistance for modern medicine?

Infections that were once treatable with antibiotics may become life-threatening Signup and view all the answers

What is the primary reason why antibiotic-resistant infections are a major cause of death and increased healthcare costs worldwide?

The overuse and misuse of antibiotics, leading to genetic selection in favor of resistant bacteria Signup and view all the answers

What percentage of patients who acquire an infection will develop a healthcare-associated infection?

5-10% Signup and view all the answers

What is the main consequence of the spread of resistant strains from developing countries to developed countries?

The increased risk of antibiotic-resistant infections in developed countries Signup and view all the answers

Why are antibiotics often used in animals for food?

To prevent illness Signup and view all the answers

What is the primary mechanism by which bacteria can resist the effects of antibiotics?

All of the above Signup and view all the answers

What is the primary source of antibiotic resistance?

Humans Signup and view all the answers

What is the primary consequence of antibiotic resistance for high-risk patients, such as the elderly and transplant patients?

An increased risk of incurable infections Signup and view all the answers

What is the consequence of antibiotic resistance in developing countries?

All of the above Signup and view all the answers

What is the primary method of transmission of resistant bacteria between humans?

Direct person-to-person contact Signup and view all the answers

What is the main factor contributing to the increased healthcare costs associated with antibiotic resistance?

The high cost of treating antibiotic-resistant infections Signup and view all the answers

What is the result of the widespread use of antibiotics in animals for food?

Increased antibiotic resistance Signup and view all the answers

What is the primary consequence of the reemergence of infectious diseases that were once nearly eradicated?

An increased risk of infection Signup and view all the answers

What is the main implication of antibiotic resistance for society as a whole?

An increased risk of infection, increased healthcare costs, and reduced worker productivity Signup and view all the answers

What is the primary concern with the use of sub-therapeutic dosages of antibiotics in animals?

All of the above Signup and view all the answers

What is the primary consequence of the overuse and misuse of antibiotics in the agricultural industry?

An increased risk of antibiotic-resistant infections Signup and view all the answers

What is the result of antibiotic resistance on the treatment of common infectious diseases?

Decreased treatment efficacy Signup and view all the answers

What is the primary factor contributing to the spread of antibiotic resistance?

All of the above Signup and view all the answers

What is the consequence of a prolonged delay in developing new replacement treatments for antibiotic-resistant infections?

Increased morbidity and mortality Signup and view all the answers

What is the main genetic change in bacteria that occurs in response to environmental stress such as antibiotics?

Acquisition of antibiotic-deactivating enzymes Signup and view all the answers

What is the implication of antibiotic resistance developing without selective pressure?

Significant fitness advantage of mutated bacteria Signup and view all the answers

How does a mutation that allows bacteria to survive antibiotics become fixed in the gene pool?

By reproducing and passing the mutation to offspring Signup and view all the answers

What mechanism could lead to antibiotic resistance against unrelated antibiotics?

Development of a structure that pumps antibiotics out of the cell Signup and view all the answers

What role do mutations and selection play in antibiotic resistance?

Allowing the survival and proliferation of resistant bacteria Signup and view all the answers

What is the result of mutated bacteria outcompeting non-mutated bacteria?

Mutation becoming fixed in the gene pool Signup and view all the answers

What is the primary concern regarding the transmission of bacteria between humans and animals?

The role of horizontal gene transfer in spreading resistance genes Signup and view all the answers

How do some bacteria acquire resistance genes according to the given text?

From other bacterial strains through horizontal gene transfer Signup and view all the answers

Why is the small infectious dose of bacteria like Shigella significant?

It makes treating the infection with antibiotics challenging Signup and view all the answers

What contributes to the development of resistant bacterial strains that survive treatment?

Acquiring resistance genes through horizontal gene transfer Signup and view all the answers

Why is antibiotic resistance a growing concern in medicine?

As resistant strains can survive treatment and pass resistance genes to others Signup and view all the answers

What could make organisms more susceptible to specific antibiotics according to the text?

Increase in immunity making them less susceptible to specific antibiotics Signup and view all the answers

What is the estimated annual spending on infections due to HA-MRSA?

$6.3 billion Signup and view all the answers

What percentage of persons over 65 take antibiotics annually?

40% Signup and view all the answers

What is the estimated total lost work days due to antibiotic-resistant infections in the US?

25 million Signup and view all the answers

What is the estimated cost of MRSA infection per case in Australia?

$26,500 Signup and view all the answers

What is the estimated increase in hospitalization costs for patients with MRSA compared to control patients in the US?

$6,633 Signup and view all the answers

What is the reason for physicians prescribing broad-spectrum antibiotics for minor infections?

Due to pressure from patients who believe antibiotic treatment is the best option Signup and view all the answers

What is the estimated cost of antibiotic-resistant infections in the US in 1995?

$5 billion Signup and view all the answers

What is the consequence of the widespread loss of effective antibiotics?

It will negate the gains in healthcare and economic development Signup and view all the answers

What is the reason for pharmaceutical companies being less inclined to invest in new antibiotics?

They see it as less profitable Signup and view all the answers

What is the consequence of resistant infections on the household and national levels in developing countries?

It will perpetuate the poverty cycle Signup and view all the answers

What is the primary consequence of antibiotic resistance in developing countries?

Tens of millions of lives lost due to the spread of resistant strains Signup and view all the answers

What is the characteristic of Extensive-drug resistant TB (XDR-TB)?

Resistance to all first-line TB drugs and some second-line drugs Signup and view all the answers

What is the impact of antibiotic resistance on hospitalization rates?

An increase in hospitalization rates due to longer illness periods Signup and view all the answers

What is the consequence of antibiotic resistance on the treatment of infectious diseases?

Increased risk of spreading diseases to others Signup and view all the answers

What is the impact of antibiotic resistance on medical care?

Increased risk of further complications Signup and view all the answers

What is the consequence of antibiotic resistance on patients with compromised immune systems?

Increased risk of life-threatening infections Signup and view all the answers

What is the outcome of antibiotic resistance on the cure rate of multi-drug resistant tuberculosis?

Cure rate of less than 50% in some parts of the world Signup and view all the answers

What is the impact of antibiotic resistance on public health?

Threat to public health due to the spread of resistant strains Signup and view all the answers

What is the consequence of antibiotic resistance on the economy?

Increased economic costs due to prolonged illness periods Signup and view all the answers

What is the outcome of antibiotic resistance on the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections?

No effective treatment options available Signup and view all the answers

What is the primary consequence of the pharmaceutical industry not developing a new class of antibiotic in over two decades?

Higher morbidity and mortality Signup and view all the answers

What is the role of computer-based rational design in the development of new antimicrobial compounds?

To design new antimicrobial compounds Signup and view all the answers

What is the primary benefit of implementing a system of transferable exclusivity vouchers for new antibiotics?

Greater incentive for the development of drugs targeted at diseases with market failure Signup and view all the answers

What is the primary challenge in ensuring a sustainable supply of antimicrobial agents?

Supply chain breakdowns Signup and view all the answers

What is the primary role of biotechnology in the development of new antimicrobial compounds?

To design new antimicrobial compounds Signup and view all the answers

What is the primary goal of replenishing the antibiotic armamentarium?

To improve public health Signup and view all the answers

What is the primary consequence of antibiotic resistance in global health security?

Compromised ability to treat infections, leading to high health costs and potential reversed advances in medical technology Signup and view all the answers

What is the main challenge in developing new antibiotics?

The extensive cost and testing required for developing new antibiotics Signup and view all the answers

What is the consequence of the spread of antibiotic-resistant infections through international travel and trade?

Deterring foreign direct investment and tourism, leading to restrictions on products and international travel Signup and view all the answers

What is the impact of antibiotic resistance on medical achievements?

It poses a risk to medical achievements, such as organ transplantation, cancer therapy, and cardiac surgery Signup and view all the answers

What is the consequence of the limited development of new antibiotics?

It has resulted in the increased spread of antibiotic-resistant infections Signup and view all the answers

What is the primary reason for the reduced effectiveness of antibiotics in treating infections?

The overuse of antibiotics, leading to the development of antibiotic-resistant infections Signup and view all the answers

What is the consequence of the increased prevalence of antibiotic-resistant infections in developing countries?

It has resulted in increased morbidity and mortality rates Signup and view all the answers

What is the primary concern with the global spread of antibiotic-resistant infections?

It poses a significant threat to global health security, compromising the ability to treat infections and leading to high health costs and potential reversed advances in medical technology Signup and view all the answers

What is the consequence of the lack of high-quality data on the burden of diseases and mortality associated with resistant infections?

It has hindered policy decisions, making it challenging to allocate resources effectively Signup and view all the answers

What is the primary challenge in addressing antibiotic resistance?

It is a complex problem that requires immediate action and cooperation from various stakeholders Signup and view all the answers

What is the estimated annual economic benefit of successful control of infectious diseases in developing countries?

$33 billion Signup and view all the answers

What is the primary goal of antibiotic stewardship programs?

To limit the overuse of antibiotics and ensure patients receive the most appropriate treatment Signup and view all the answers

What is the consequence of antibiotic resistance in developing countries?

Limited access to modern medical procedures Signup and view all the answers

What is the primary strategy to combat antibiotic resistance?

Antibiotic stewardship programs Signup and view all the answers

What is the result of public education on the risks of antibiotic misuse and the benefits of restricting their use?

Decreased use of antibiotics Signup and view all the answers

What is the primary benefit of strengthening infection prevention and control measures?

Reduced risk of antibiotic resistance Signup and view all the answers

What is the consequence of antibiotic use in the treatment of infections?

Resistant organisms thrive Signup and view all the answers

What is the primary challenge in preventing and controlling antibiotic resistance?

Complex decision-making processes and uncertainty of diagnosis Signup and view all the answers

What is the primary goal of initiatives to prevent further antibiotic resistance?

To improve and measure the appropriate use of antimicrobial agents Signup and view all the answers

What is the consequence of successful implementation of antibiotic stewardship programs?

Reduced spread of resistant strains Signup and view all the answers

What is one of the primary concerns associated with drug resistance according to the text?

Prolonged disability and death Signup and view all the answers

How does drug resistance impact the transmission of infectious diseases?

Negatively affects the transmission Signup and view all the answers

What effect does high-level antibiotic resistance in commensal organisms like E.coli have on surgical prophylaxis?

Increases the risk of surgical site infections Signup and view all the answers

What does the text suggest about the outcome of infections caused by MRSA?

MRSA individuals are 64% more likely to die Signup and view all the answers

What is the relationship between morbidity and the pool of infectious people within a community?

Morbidity increases the pool of infectious people Signup and view all the answers

How do resistant strains impact illness periods and morbidity rates compared to non-resistant strains?

Lengthen illness periods and increase morbidity rates Signup and view all the answers

Study Notes

Antibiotic Resistance Introduction

Antibiotic resistance has led to treatment failure in patients with pneumococcal meningitis, resulting in permanent hearing loss
Antibiotic resistance is costly, with increased medical costs and longer treatment durations, impacting health insurance companies and governments
Antibiotic resistance requires urgent attention and action to address the issue

Definition of Antibiotic Resistance

Antibiotics inhibit the growth of bacteria and are used to treat infections
The misuse and overuse of antibiotics have led to the evolution of antibiotic-resistant bacteria, rendering antibiotics ineffective
Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections

Importance of Studying Antibiotic Resistance

Antibiotic therapy has benefits, but it also has negative aspects, such as causing more problems than the infections they treat
Newer antibiotics are generally more expensive and are only available in intravenous form
Unrestricted use of antibiotics can have economic consequences, making it difficult to justify the cost of expensive new antibiotics for minor infections

Genetic Mechanisms of Antibiotic Resistance

Antibiotic resistance can be categorized into two main genetic mechanisms: mutation and horizontal gene transfer
Mutation is a permanent change in a gene's DNA sequence, which is particularly susceptible to antibiotics
Horizontal gene transfer (HGT) is a process where a microorganism acquires genes from another without being the offspring of that microorganism

Efflux Pump Systems

Efflux pump systems are essential in removing antibiotics from bacterial cells, originating from the transport of nutrients
These systems, which typically consist of a cytoplasmic membrane protein, a periplasmic membrane fusion protein, and an outer membrane protein, are specific for each major class of antibiotics synthesized by microorganisms in the soil
Examples of efflux pump systems include the TetA system in E. coli and the MtrCDE system in Neisseria gonorrhoeae

Mechanisms of Action of Efflux Pump Systems

Efflux pump proteins, consisting of up to three subunits, span the cell envelope of Gram-negative bacteria
These systems transport substrates from the cytoplasm to the outside of the cell or into the periplasm, using proton motive force (PMF) as an energy source
Substrates are often toxic or inhibitory to the bacterium, and efflux allows bacteria to maintain a less toxic intracellular environment, avoid inhibitory effects, and resist the bactericidal or bacteriostatic effects of antibiotics

Enzymatic Inactivation

Enzymatic inactivation is a process where operable enzymes modify the structure of antibiotics, making them less effective
These enzymes can be specific targets for antibiotics, causing only a small change in their active site to prevent them from functioning
Examples of enzymatic inactivation include beta-lactamases and erythromycin esterases

Target Modification

Target modification is a process where the target of an antibiotic is altered, reducing its binding affinity
Examples of target modification include high-level Tcr Mpr bacteria, which are resistant to macrolide lincosamide and streptogramin B MLS antibiotics due to a point mutation that prevents MLS antibiotic binding
Other examples include the modification of ribosomal proteins, which can reduce the binding affinity of an antibiotic to its target

Biofilm Formation

Biofilm formation is a crucial strategy for the survival of microbes, involving microorganisms becoming irreversibly associated with a surface and encased in an extracellular polymeric matrix
Biofilms often become resistant to antibiotics and disinfectant chemicals, leading to chronic infections
The acquisition of resistance genes by biofilm bacteria is one proposed mechanism for high levels of drug tolerance### Mechanisms of Antibiotics Resistance
Antibiotics resistance occurs through various mechanisms, including efflux systems, modification, and horizontal gene transfer
Efflux systems are energy-dependent processes that extrude antibiotics across cellular membranes
There are five classes of efflux systems, including MF, MFS, resistance nodulation cell division, and ABC

Examples of Antibiotics Efflux Systems

AcrAB is a tripartite efflux system in Escherichia coli that recognizes and expels various substrates
QacA multidrug efflux pump in Staphylococcus confers resistance to various organic cationic compounds
SatAB efflux system in Enterococcus faecium confers high-level resistance to many antibiotics

Antibiotics Modification

Antibiotics can be modified through various mechanisms, including inactivation by enzymes, alteration of the target site, and reduced accumulation inside the bacteria
Examples of antibiotics modification include penicillinase, which hydrolyzes the β-lactam ring of penicillin, and erythromycin resistance in bacteria due to the production of an esterase

Factors Contributing to Antibiotics Resistance

Misuse and overuse of antibiotics contribute to the development of antibiotic-resistant bacteria
Factors contributing to antibiotic resistance include misuse, accessibility, incomplete use, and the possibility of causing mutations in the bacteria's genes
Agricultural use of antibiotics, particularly in animal husbandry, also contributes to the development of antibiotic-resistant bacteria

Inappropriate Prescribing Practices

Inappropriate prescribing practices, including taking antibiotics for viral infections, contribute to antibiotic resistance
Delaying antibiotics prescriptions for conditions where they may be necessary can help reduce antibiotic resistance

Self-Medication

Self-medication with antibiotics is a risky behavior that can contribute to antibiotic resistance
Many people use leftover antibiotics from previous prescriptions or purchase them without a prescription, which can lead to misdiagnosis and misused antibiotics### Lack of Public Awareness and Education on Antibiotics
Public's perception of antibiotics as a magic drug for various illnesses stems from limited knowledge and lack of consultation time in health services
Misuse and abuse of antibiotics contribute to antibiotic resistance
Public knowledge on appropriate use of antibiotics is crucial to reduce antibiotic resistance
Patients may not complete a full course of antibiotics prescribed to them or save some for later use, leading to antibiotic resistance
Certain groups, such as the elderly, those in poverty, and minority groups, may have limited access to adequate healthcare and may only be able to obtain or afford outdated or used antibiotics

Insufficient Knowledge on Proper Antibiotic Use

Misuse of antibiotics is a significant issue, often due to a lack of understanding of the implications of incorrect usage
Patients may not complete a full course of antibiotics prescribed to them or save some for later use, leading to antibiotic resistance
Nearly half of antimicrobial therapy for respiratory tract infections may be unnecessary
25% of respondents believe the best treatment for a cold is antibiotics

Limited Understanding of Antibiotic Resistance

Antibiotic resistance is a complex issue that has not been given the attention it deserves due to a lack of understanding among the general public, health workers, and policymakers
Many doctors and nurses do not feel well informed about the impact of antibiotic resistance
Patients often have unrealistic expectations of antibiotics and do not understand why their use is restricted in the face of resistance
Pharmaceutical companies have stopped antibiotic research and focus on more profitable areas due to reduced demand for newer, more potent antibiotics

Poor Infection Prevention and Control

Infection prevention and control in developing countries are often inadequate, leading to higher rates of antibiotic resistance
Patients in these areas are at a higher risk of contracting infections while hospitalized
Antibiotic-resistant bacteria can be acquired in healthcare facilities due to exposure to higher levels of antibiotics
Infections do not respect international borders, and failure to prevent and control infections can affect the health of people in other countries

Inadequate Hand Hygiene

Hand hygiene is crucial in healthcare settings, particularly when healthcare workers come into contact with a patient's body or environment
The World Health Organization's "five moments for hand hygiene" framework outlines key moments when healthcare workers should perform hand hygiene
Low adherence to hand hygiene practices in all settings, with low adherence being particularly high after contact with a patient's skin or wound, body fluids, and patient contact

Inadequate Sterilization Practices

Sterilization is the process of eliminating or destroying all forms of microbial life to prevent infection in medical and surgical procedures
Factors such as the item's nature, intended use, microorganism resistance, adverse effects on the material, and cost and safety of the method should be considered
Sanitization does not imply sterilization, and disinfection and antisepsis are separate terms that should not be confused with sterilization

Poor Sanitation and Hygiene in Healthcare Settings

Infections in healthcare settings are often caused by inadequate sanitation and poor disinfection practices
Only 40% of countries meet minimal standards, and the extent of these standards is often questionable
Healthcare facilities are often vectors for spreading disease

Global Travel and Migration

As the world becomes more globalized, pathogens are becoming more likely to travel between places, leading to an increase in antibiotic resistance
Developing countries tend to have higher antibiotic resistance due to unregulated and easily obtainable antibiotics
The spread of resistant strains from developing countries to developed countries could lead to high morbidity and mortality rates

Transmission of Resistant Bacteria across Borders

The rise in international travel and commerce has led to the spread of antibiotic-resistant bacteria from high antibiotic use areas to low antibiotic use areas
Travelling to developing countries with high antibiotic use rates may increase the risk of becoming a carrier of resistant strains
Studies have shown that 21% of healthy western travelers to highly endemic areas became faecal carriers of resistant bacteria

Importation of Resistant Strains

The risk of importing resistant strains of bacteria is not limited to tourists, as refugees and immigrants returning to their countries of origin often carry these organisms
War and natural disasters can lead to large movements of people from affected countries to other regions or back to their own countries, potentially resulting in outbreaks of infection with imported strains

Genetic Transfer of Resistance

Horizontal gene transfer in bacteria involves the transfer of genetic information from one chromosome to another, potentially leading to antibiotic resistance
This movement of DNA can occur between bacteria of different genera or species, making it difficult to eradicate resistant strains
The primary means of DNA transfer from a donor cell to a recipient is through recombination, which can occur in three main ways: transformation, conjugation, and transduction

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Description

Learn about the mechanisms of antibiotics resistance, how bacteria can cause infections, and the discovery of antibiotics. Explore the effectiveness of antibiotics against gram-positive bacteria, such as staphylococci and streptococci.