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Antibiotic Awareness Week, November 2011Rita Finley, Lynora Saxinger, Daniel ThirionTranscription: Marjolaine HébertRenéeAnd so, what we should really be looking at doing is having peoplestop treatment before the risk-benefit crosses and follow the patientfor outcomes. And with that I’m going to close.Thank you very much, doctor Saxinger. It’s really interesting. And,because we’re a bit tight on time, I’m going to hold off on thequestions for now, but I will just mention that the presentations willbe available on our website. They will be translated and available onour website, at AntibioticAwareness.ca for those who want to seethem afterwards. And with that, I will introduce our next speaker,which is doctor Daniel Thirion. And he is Clinical Associate Professorand Pharmacist at the Faculty of Pharmacy, Université de Montréal,and McGill University Health Centre. Hello Daniel. Are you there?Yes I am. Hello everyone. Thank you for inviting me again for thisopportunity, a presentation on Antimicrobial Resistance. First, I wantto thank also the first two speakers, who have done an excellent jobon presenting two important issues in regards to antimicrobialresistance.What I’m going to try to do is present different aspects that wereinitially discussed, and hopefully, this will give a complete view of theissues surrounding antimicrobial resistance. So, actually, I’m justgonna skip the objectives. Initially, what I was going to present wasperspective of the global problem on antimicrobial resistance, thepathways to resistance, and just identify some of the concerns ofresistance in Canada and try to identify the strategies that we’reimplementing to avoid emergence of resistance and how we have toadapt therapy and practice.So usually, when I present antimicrobial resistance to clinicians, thisis a slide I use; it takes about half an hour to explain. And I’ll go overit much quicker. The important concepts that are needed tounderstand, first is the genetic development of antimicrobialresistance, and selection of resistance in a single patient. This isactually very well explained on the FDA video that’s available if youjust look on, through Google, it’s actually pretty easy to find. And so,genetic development of resistance, I think, was well explained on thefirst two presentations, and I won’t go over that. And selection ofresistance actually was also well explained by Dr. Saxinger, so I won’tPUBLIC HEALTH AGENCY of CANADA//AGENCE DE LA SANTÉ PUBLIQUE du CANADA 20
Antibiotic Awareness Week, November 2011Rita Finley, Lynora Saxinger, Daniel ThirionTranscription: Marjolaine Hébertgo into that.What’s important also to recognize, is the emergence of resistanceeither through therapy or through a population. And this also was...Ithink I’m putting an emphasis again on this, there are some infectionsand specific species of bacteria who are more susceptible to produceresistance when they are exposed to antibiotics. And we see this incommunity, associated with Streptococcus pneumoniae. Or we cansee this maybe more in the hospital, associated with gram negativeinfections.And as we look toward the other end of the spectrum, we know thatsome bacteria are actually more susceptible to transmission ofresistance than the strains of resistance, and this we see more withMRSAs. So, as already mentioned, for Staph aureus, the mostimportant interventions are infection control. And with otherresistance such as Strep pneumo, the most important interventions isantimicrobial stewardship. And I think, overall, if we want to curbthis, we want to be able to maintain both of these programs, infectioncontrol and stewardship as a collaborative practice, to be able toaddress the whole issue of antimicrobial resistance in ourpopulations.Next point is laboratory testing for resistance, so if you want tounderstand resistance and the problems, you have to be able tounderstand the laboratory aspects of testing for resistance and howyou detect it and interpret those results.And after that, you go on to empiric drug selection according to thoseresults, and adjust therapy according to sensitivity results. We alsoadjust empiric drug therapy according to surveillance studies thatshow us some patterns of resistance in certain areas that are eitherin the hospital or in the community setting.Okay, so that goes over that slide in about...record time.Just so that we understand what’s going on, and again, this waspresented a little bit earlier, I’m gonna go to the next slide. I knowthere’s some lag so I hope this pops up at the same time I see it. If youlook at this graphic that was published about ten years ago, it showsthe mortality rate per 100 000 patient years in the 20 th century. Andwe see that mortality rate associated to infectious diseases was closePUBLIC HEALTH AGENCY of CANADA//AGENCE DE LA SANTÉ PUBLIQUE du CANADA 21
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