Micro Final -Antibiotic Susceptibility

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Chemical substance produced by a microorganism that inhibits the growth of or kills other microorganisms (primarily bacteria)

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antibiotic

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-Prokaryotic bacteria have different cellular structures and metabolic pathways from eukaryotes; advantageous
-Antimycobacterial

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antibacterial or antibiotic

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inhibit viral replication

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antiviral

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-bind to fungal cell membrane sterols; interfere with sterol synthesis; block mitosis or nucleic acid synthesis; inhibit cell wall synthesis
-toxic to host

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Antifungal

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-interfere with DNA & RNA synthesis; interfere with protozoal metabolism
-Antiprotozoal
-Antihelminth
-Toxic to host

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Antiparasitic

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mainly fungal source antibiotic

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Natural antibiotic

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chemically altered natural compound antibiotic

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semi -synthetic antibiotic

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antiobiotic chemically designed in the lab

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synthetic antibiotic

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antibiotics have an inverse relationship between _________ and __________

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toxicity and effectiveness

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-Operate by impairing crucial life sustaining processes in the microbe (i.e.- inhibition of components necessary for bacterial growth)
-Inhibits or kill infecting organism in its active form
-Some antibiotics work at several sites in the body, while others are limited only to specific tissues

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Antibiotics mode of action

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targets of antibiotic

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-component necessary for bacterial growth
-should be selective to minimize toxicity

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based on the # of bacterial species drug is active against

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spectrum of activity

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ability of bacterial strain to replicate following antibiotic exposure

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bacterial sensitivity

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ratio of min. conc. likely to produce an adverse effect to min. conc. to produce desired effect

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therapeutic index

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delivery of antibiotic to site of infection

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delivery of antibiotic to site infection

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Inhibit bacterial multiplication; replication can resume if antibiotic is discontinued

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bacteriostatic

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drug concentration at which bacterial population is inhibited

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MIC

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Causes permanent loss of bacterial replicative ability

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bactericidal

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drug concentration at which bacterial population is killed

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MBC

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-refers to the movement of drug into, through, and out of the body—the time course of its absorption, bioavailability, distribution, metabolism, and excretion
-Determines the onset, duration, and intensity of a drug's effect

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pharmokinetics

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-involves receptor binding and chemical interactions
-Cidal vs. static activity
-Concentration vs. time-dependent killing
-Toxicity
-Allergy
-Antibiotic-assoc diarrhea

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pharmacodynamics

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relationship between dose and response

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PK/PD relationship

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-largest group of antibiotics, multiple derivatives
-broad spectrum
-Inhibit bacterial cell wall (peptidoglycan) synthesis by binding to and inhibiting regulatory enzymes (also called penicillin binding proteins [PBPs])
-kills growing cells only

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Beta- Lactams

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Specific for:
-Penicillins (penicillinases)
-Cephalosporins (cephalosporinases)
-Carbapenems (metallo-beta-lactamases)

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Beta- lactamases

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-vancomycin is most commonly used member in this group
-inhibits cell wall synthesis

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Glycopeptides

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-inhibits peptidoglycan synthesis
-active agaisnt gram positive only
-bactericidal

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Vancomycin

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-insert into bacterial membranes
-produce increased cell permeability
-cell death
-gram pos. intrisically resistant
-toxicity associated with use, esp. nephrotoxicity

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polypeptides

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-Binds irreversibly to components
of the inner cell membrane of susceptible organisms
-causes rapid depolarization
-inhibits intracellular synthesis of DNA/RNA
-gram neg. naturally resistant

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lipopeptides

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-interfere with the action of DNA gyrase
-These have a broad spectrum of activity which can vary widely with each individual quinolone agent

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fluorquinolones

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-Identification of causative organism
-Antibiotic susceptibility of the organism
-Follow-up of drug effectiveness
-Monitor antibiotic level to avoid toxicity
-Post-antibiotic effect

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Factors in choosing antibiotic therapy

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-Suspect infection, lack cultures
-Initially, most patients requiring antimicrobial are treated with this type of antibiotic prescription

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emperic

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-documented infection type of antibiotic prescription

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therapeutic

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-infection prevention type of antibiotic prescription

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prophylactic

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when do you NOT perform susceptibility testing?

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when the becterium is predictably sensitive to the agents commonly used to treat the organism

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-drug diffuses out of disk into agar
-creates concentration gradient of drug

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Kirby-Bauer method

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-Plastic strip immobilized with a pre-formed and pre-defined antimicrobial gradient

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ETest

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primary agents and should be reported first

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Group A

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-later generation agents and should be reported if isolate is resistant to primary agent,infection does not respond to primary agent, patient cannot tolerate primary agent

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Group B

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-May be tested routinely when a large number of resistant strains are found in an institution
-Have very-broad spectrum activity and may be needed in polymicrobial infections

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Group C agents

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changes that result in the organism being less susceptible to a particular drug than has been seen before

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Biological resistance

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antimicrobial susceptibility that has been lost to such an extent that the drug is no longer effective for clinical use against that organism

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clinical resistance

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Resistance that directly results from physical or chemical characteristics of the environment that either directly alter the antimicrobial agent or alter the microorganisms normal physiologic response to the drug

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enviromentally mediated resistance

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-Refers to genetically encoded
-Can be constituitively expressed or induced

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micro-organism mediated resistance