understanding antibiotic resistance in u

Presentation by Moroto MTC

1. Understanding Antibiotic Resistance The silent Global Threat By: Dr Oloya Johnson Nyeko Chair-MTC-MoRRH

2. introduction Antimicrobial resistance (AMR) is the ability of microorganism to withstand the effects of medications designed to kill or inhibit their growth. It is a pressing global health challenge The infections that were once easily treatable are becoming increasingly difficult to manage, leading to prolonged illness, increased healthcare costs, and a higher risk of mortality.

3. Antibiotic usage has led to the rise of germs that are widely multi-drug resistant, rendering even the most potent medications useless[ It’s a growing public concern worldwide. Every year over 700,000 death are linked to AMR A significant proportion AMR deaths occurs in low to middle-income countries (LMIC) By 2050 over 10million death would have occurred

4. Infections caused by resistant microbes that fail to respond to treatment result in prolonged illness and greater risk of death. When infections become resistant to first-line antimicrobials, treatment must be switched to second-line or even third-line drugs, which are sometimes more toxic than the drugs they replace. Treatment failures also lead to longer periods of infection, and this factor increases the numbers of infected people moving from hospitals into the community

5. AMR in Uganda (UNIPH 2028-2021) The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). Trends of total antimicrobial resistance of Gram-positive organisms to common antibiotics in the period of 5years

6. Rates of resistance of Gram-negative organisms to common antibiotics has increased over the 5 years. Resistance to penicillins (Piperacillin and Ampicillin) was highest among Gram negative bacteria. Specifically; Ceftriaxone (8.3-78.6%), Ciprofloxacin (17.1-42.6%), Imipenem (5.7-29.7%), Meropenem (5.3-18.4%) And Tetracycline (28.6%-81.6)

7. Antibacterial agents Antibiotics are medications that destroy bacterial infections

8. Microbial Resistance Mechanisms Genetic Adaptation : Microbes develop resistance through mutations or by acquiring resistance genes from other bacteria via horizontal gene transfer. Over time, these resistant strains become dominant due to selective pressure from antibiotic use. Mechanisms of resistance fall into four main categories: (1) limiting uptake of a drug; (2) modifying a drug target; (3) inactivating a drug; 4) active drug efflux.

9. Effects on Body While antibiotics are effective against harmful bacteria, they can also disrupt the balance of beneficial bacteria in the body resulting into diarhea It decrease the amount of a helpful bacteria, lactobacillus, in the vagina resulting into vaginal candidiasis. A fever may occur because of an allergic reactions. These side effects highlight the need for responsible use.

10. Main Causes of Resistance

11. 1. Over-prescription of antimicrobials: particularly antibiotics, by physicians. Such overuse is fueled, in part by; Patient expectations and demands. Growing patient awareness of antimicrobial agents sets up an expectation among patients that they should receive such drugs, even in the absence of appropriate indications. Diagnostic uncertainty Lack of opportunity for patient follow-up Pressure to minimize length of office visits that precludes proper patient education lack of knowledge regarding optimal therapies—may influence

12. In many developing countries, antimicrobial agents are readily available and can be purchased as a commodity without the advice or prescription. In such settings, drugs are often of questionable quality, with less than full potency, thereby possibly promoting the emergence of resistant pathogenic organisms

13. 2. Hospital Acquired Infections: Hospitals also are fertile breeding grounds for microbial resistance. The immunosuppressed patients who lack the basic are unable to eliminate pathogens Intensive and prolonged antimicrobial use Close proximity among patients in wards, And invasive procedures have resulted in hospital-acquired infections. The failure of health care workers to practice infection control measures (e.g., hand washing) contributes to the spread of infection in hospitals

14. 3. Patients Behaviors: Some common types of human behavior increasingly play a role in promoting resistance. Such behaviors; Failure to complete recommended treatment Noncompliance occurs when individuals forget to take medication, prematurely discontinue the medication as they begin to feel better, or realize that they are unable to afford a full course of therapy. Self-medication with antimicrobials almost always involves unnecessary, inadequate, and ill-timed dosing—creating an ideal environment for microbes to adapt rather than be eliminated.

15. 4. Use of Antimicrobials on Animals: Overuse of antimicrobial agents in animals raised commercially for food, such as poultry, pigs, and cows for either therapeutic use or to promote growth. This can lead to the development of drug-resistant microbes (largely bacteria, such as salmonella and campylobacter) that are then transmitted to humans. Concern also is growing about the role played by the accumulation of low levels of antimicrobials derived from consuming animal products in the emergence of resistant pathogens among humans

16. Consequences of Resistance Health Impact : Longer Illness : Infections caused by resistant bacteria are harder to treat and take longer to cure, leading to prolonged illness. Increased Mortality : Resistance can lead to treatment failure, putting patients at higher risk of death. Increase in antimicrobial resistance have led to fewer treatment options for patients, increase in morbidity and mortality

17. Economic Burden : Higher Treatment Costs : Treating resistant infections is significantly more expensive due to the need for alternative or more potent antibiotics. we are facing more severe infections needing more extensive treatment, and longer courses Example: Treating multi-drug-resistant tuberculosis can be more than 100 times more expensive than treating non-resistant TB.

18. MTC-studies done at mOrrH

19. Prescription Audit May 14th 198 patient files were studied. Found 148 patients received antibiotics, 75% received antibiotics, however, 35% received antibiotics as per their diagnosis 70% received one antibiotics 28% received 2 antibiotics 2% received 3 antibiotics

20. Prescription in according to 2023 UCG In line Not in line Defined diagnosis 92% 8% Correct dose 19% 81% Correct duration 20% 80% Correct molecule/drug management 39% 61% Overall adherence 15% 85%

21. Point Prevalence Survey (PPS) on Antibiotic Use May 14 th 91% patients received antibiotics. Among patients on antibiotics: 32% 1 antibiotic 57% 2 antibiotics 11% ≥3 antibiotics Ward Patients included Maternity 13 Pediatric 42 Medical 23 Neonatal 7 Surgery 22 Total 107

22. Indication for prescription 33% of indication of antibiotic use wasn’t related to community/hospital acquired infections or prophylaxis 15% of indications are surgical prophylaxis Community Acquired Infections (CAI) account for 52% of cases, but they may be overestimated since HAIs are underdiagnosed Among the patient who need an antibiotic, No Healthcare Acquired Infections (HAI) indicator was identified

23. Patients with missed doses (%) and reasons 54% Patients with missed doses (total missed doses 351) TARGET Reasons for missed doses. Drug stock outs Patient not in bed No staff on duty others

24. Culture & sensitivity test at morrh

25. Microorganisms isolated from urine samples

26. Resistance of E. coli to Antibiotics E.Coli is showing resistance to 92% of common antibiotics. With 100% susceptibility to Imipenem

27. Microorganism detected in HVs

28. Susceptibility of Staphylococcus to Antibiotics

29. Discussion

30. Control Measures Specific initiatives that could help to control the emergence of resistance: • Expand efforts to prevent hospital-acquired infections. Important activities include; Surveillance Outbreak investigation and control, Sterilization and disinfection of equipment, and Proper confinement of patients infected with resistant microbes Ensure patients receive drugs as prescribed. • Enforce infection prevention & control measures among health care workers.

31. Improve physicians’ prescribing practices through such means as Education Formulary restrictions Multidisciplinary drug utilization evaluation Computerized decision support systems. In all cases, the commitment and participation of the prescribing clinician and the health care institution are essential. Hospitals and clinics may derive direct financial benefits from such improved prescription practices

32. Ensure that patients comply with recommended drug therapies. By; Educating patients about the prescribed drug, The importance of completing dose The time and frequency of drug intake And possible side effects • Tailor education and intervention programs to specific persons.

33. • Prevent misuse and overuse of antimicrobial agents in agriculture. This should include identifying critical control points along the continuum of food production.

34. Expand public education efforts to explain why treatment with antibiotics is not always the best medicine. Antibiotics only work to treat bacterial infections. They don’t work for infections caused by viruses, fungi and others

35. Why Prescribing Wisely Matters Preventing Resistance Appropriate prescription practices are critical in preventing the development of antibiotic resistance. Prescribe antibiotics only when necessary and following guidelines. Improving Patient Outcomes Correctly prescribed antibiotics lead to better patient outcomes, including faster healing and reduced risk of complications. Evidence-based prescribing not only helps patients but also protects public health.

36. Cost-Effectiveness Avoiding resistance through appropriate prescribing can significantly reduce healthcare costs. Treating resistant infections often requires more expensive and invasive interventions, burdening both patients and healthcare systems. Building Trust Patients are more likely to trust providers who discuss antibiotic use openly. Healthcare provider can foster a collaborative relationship if they educate patients about why antibiotics are necessary or not.

37. Role of Healthcare Providers in Prevention Key Responsibilities in Combating Resistance Educating Patients Healthcare providers play a pivotal role in patient education regarding the appropriate use of antibiotics. This includes explaining when antibiotics are needed and the dangers of misuse or overuse, thereby fostering responsible behaviors. Collaborating with Colleagues Interdisciplinary collaboration among healthcare providers enhances antibiotic stewardship efforts. Sharing knowledge about resistance patterns and effective treatments can lead to more informed prescribing practices. Monitoring Outcomes Regularly monitoring and reviewing patient outcomes helps identify patterns of resistance and treatment failures.

38. DON’T ASK FOR A STRONGER DRUG ASK FOR A DRUG SUSCEPTIBILITY TEST

39. Thank You for Your Attention