Antimicrobial Resistance Mechanisms
?-Lactams
PPT Slide
Assessing resistance and mortality
The Alexander Project 1999: S. pneumoniae, Pen-I and Pen-R
Logistic regression analysis of penicillin resistance and mortality, invasive pneumococcal pneumonia
Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia
In-hospital medical outcomes for patients with pneumococcal pneumonia, adjusted for severity of illness
Proposed NCCLS ceftriaxone/cefotaxime/cefepime susceptibility breakpoint changes
Penicillin-resistant S. pneumoniae tend to be resistant to other ?-lactams
Macrolide Resistance
Ribosome
Mechanism of Action of MLS Antibiotics
Mechanisms of Resistance
Target modification: methylation
Efflux in S. pneumoniae
Correlation between erythromycin MICs and resistance mechanisms
The Alexander Project 1999: S. pneumoniae, Macrolide Resistance
Why haven’t we seen treatment failures in macrolide resistant pneumococci treated with macrolides?
Macrolide treatment failures with macrolide resistant S. pneumoniae
Fluoroquinolones
Topoisomerases: critical enzymes in DNA replication
How do fluoroquinolones work
Targets for the fluoroquinolones
Development of Resistance
Mechanisms of Resistance to Fluoroquinolones
Mechanism of Action of Fluoroquinolones
Spontaneous mutation
Burden of pneumococci during infection
Issues
Clinical Fluoroquinolone and Oral Cephalosporin Failures
Fluoroquinolone resistance rates in pneumococci
Decreased susceptibility of S. pneumoniae to fluoroquinolones in Canada
Fluoroquinolone use and PRSF Canada, 1988-1998
CBSN S. pneumoniae MICs for ciprofloxacin, 1993-8
Analysis of ciprofloxacin activity against S. pneumoniae after 10 years use in US
Implications
Quinolone Activity Against Ciprofloxacin-Resistant S. pneumoniae*
What does it mean clinically?
Failure of treatment of pneumococcal pneumonia with levofloxacin
Case 1
Case 2
Case 3
Case History
Course in Hospital
Case 4
Email: tulkens@facm.ucl.ac.be
Home Page: http://www.md.ucl.ac.be/seminfect/resume.htm
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