莽-Ranking of Antimicrobial Drugs According to Importance.ppt

Ranking of Antimicrobial Drugs According to Importance in Human Medicine John H. Powers, M.D. Lead Medical Officer Antimicrobial Drug Development and Resistance Initiatives Office of Drug Evaluation IV Center for Drug Evaluation and Research U.S. Food and Drug Administration Introduction Define problem of antimicrobial use in animals and relationship to antimicrobial resistance in human pathogens Background on ranking process Factors used in ranking drugs factors based on drug efficacy factors based on resistance factors of low importance The Problem Antimicrobial drug use in food-producing animals: may result is bacteria in animals resistant to drugs used to treat human illness resistant bacteria in food-producing animals may be transmitted to humans non-pathogenic bacteria originating in food-producing animals may transmit resistance traits to human pathogenic bacteria The Problem Antimicrobial use in humans may contribute to most of resistance in man Antimicrobial use in animals may also contribute Several authors debate how large a problem this is How large does it have to be to pose significant risk to human health? Because is it difficult to measure does it mean it does not exist? Avoparcin and vancomycin resistance example Examples Transmission of resistant bacteria from animals to humans enteric bacteria in animals causing food-borne disease in man most direct link Salmonella outbreak traced back pigs Molbak N Engl J Med 1999;341:1420-25. Nonenteric bacteria in animals to non-enteric bacteria in man ROB-1 beta-lactamase in Actinobacillus pleuropneumoniae from pigs transfer via plasmid to H. influenzae in man Medeiros 1986Antimicrob Agents Chemo 1986;29:212-215. possibility for gene transfer from enteric bacteria in animals to non-enteric bacteria in man van A gene in enterococci to MRSA? The Problem Transmission of resistance genes within species or from one species to another animal specific strains of bacteria can transmit genes to like org