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  1. Antibiotics are medications used to treat infections caused by a microorganism(s). They are either extracted from specific microorganisms to selectively inhibit the growth of another microorganism(s) or produced through synthetic manufacturing. Antibiotics specifically target microbes. Based on their mode of action, the antibiotics are divided into two major categories:                                             
  • Bactericidal: kills bacteria
  • Bacteriostatic: impedes bacterial growth 
  1. Antibiotic stewardship refers to improved treatment outcomes and cost savings through appropriate use of antimicrobial agents. Major outcomes in patient care are lower iatrogenic side effects and AMDR incidence. To be effective, the stewardship program should include multicultural changes in healthcare practice, with contributions and participation by the veterinary, agriculture, and industry communities.
  2. Bacteria are categorized as gram-positive and gram-negative based on their ability to retain the crystal violet dye. Many gram-negative bacteria are pathogens and cause infections. Gram-positive bacteria are responsible for both nosocomial and community-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA).
  3. cSSTI refers to a complicated skin and soft tissue infection.
  4. ESBL, or extended spectrum β-lactamase, is an enzyme produced by some bacteria; it is capable of breaking down the cephalosporin class of antibiotics and increases AMDR.
  5. Iatrogenic events are medical side effects (complications) resulting from a treatment and/or a surgical procedure.
  6. Immunocompromise denotes illness- or treatment-induced loss of effective response by the host’s immune system.
  7. Invasiveness is the ability of an infective agent to penetrate and spread in the body tissues and/or organs.
  8. Infectivity can be described as the attack rate, usually estimated by the ratio of the number of individuals contracting the illness over the number of individual exposed.
  9. Isolates are patients’ tissue or secretion samples collected for the laboratory identification and confirmation of a suspected microorganism(s) or other infective agent(s).
  10. MDRAB refers to the multidrug-resistant Acinetobacter baumanii microorganism.
  11. Microorganisms are microscopic life forms ubiquitous in the environment and on the human body. Most are harmless to humans and actually benefit many life processes. Occasionally and due to alterations in the host immunity system, they become invasive and cause infections (example: Staphylococcus aureus). Microorganisms include bacteria, protista, viruses, prions, fungi, and parasites.
  12. Microbe is a nonspecific term used to describe a microorganism(s). Specific species are identified by their proper names in the Syllabus.
  13. Microbial resistance (MR) is a generic term describing antimicrobial, antibiotic, antiviral, antifungal, antihelminthic, or antiparasitic drug resistance. MR defines the ability of a microorganism to withstand a drug that interferes with its life functions. This ability describes a diminished or failed response of an organism to the intended effectiveness of a chemical or biological agent. Resistance can involve only one drug or multiple antimicrobial drugs.
  14. MDR is multidrug resistance or mega-drug resistance; it was recently documented in infections caused by HIV/AIDS, Mycobacterium tuberculosis, and Acinetobacter species.
  15. Nosocomial refers to a hospital-acquired infection.
  16. Pantone-Valentine leukocidin (PVL) and gAMMA-hemolysin (Hlg) are synergohymenotropic toxins produced by the pvl and hlg genes of Staphylococcus aureus.
  17. Pathogen is a nonspecific term used to describe an infection-causing microorganism.
  18. Selective pressure is the influence exerted by many factors, such as antibiotic drugs, resulting in the elimination of susceptible species and promoting the natural survival of another group of microorganisms.
  19. STI describes a group of sexually transmitted infections caused by different microbes and viruses, such as Neisseria gonorrhea, Treponema pallidum (syphilis), HIV/AIDS, Chlamydia trachomatis, human papillomavirus (HPV with types 16 and 18 implicated in the genesis of cancer), Trichomonas vaginalis, herpes simplex, and others, including hepatitis. 
  1. Sentinel event is an unexpected event in a healthcare setting involving death or serious physical or psychological injury, or the risk thereof, and not related to the patient’s illness (adapted from the Joint Commission for Accreditation of Healthcare Organizations USA).
  2. Virulence defines the ability of an infective agent to cause disease. The number of microorganisms required to trigger the infection is inversely correlated with the virulence level of the infective agent. Sometimes referred to as “extremely infective pathogen” capable of a rapid course and high morbidity and mortality.

Table of Contents

SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
Test Questions
Program Evaluation
Self Assessment

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