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Associate Professor David Holland Director Infection Services Middlemore Hospital 14:00 - 16:00 WS #155: Pharmac Session: Antimicrobial Resistance - Global Threat or Myth? (120mins, not repeated) Dr Peter Moodie General Practitioner Wellington Professor Jack Heinemann Genetics and Molecular Biology School of Biological Sciences University of Canterbury Associate Professor Siouxsie Wiles Microbiologist Head of the Bioluminescent Superbugs Lab University of Auckland Mr Ben Harris Honorary Lecturer University of Otago

Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

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Page 1: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Associate Professor

David HollandDirector

Infection Services

Middlemore Hospital

14:00 - 16:00 WS #155: Pharmac Session: Antimicrobial Resistance -

Global Threat or Myth? (120mins, not repeated)

Dr Peter MoodieGeneral Practitioner

Wellington

Professor Jack

HeinemannGenetics and Molecular Biology

School of Biological Sciences

University of Canterbury

Associate Professor

Siouxsie WilesMicrobiologist

Head of the Bioluminescent Superbugs Lab

University of Auckland

Mr Ben HarrisHonorary Lecturer

University of Otago

Page 2: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Mechanisms of antimicrobial resistance

Associate Professor Siouxsie Wiles

Bioluminescent Superbugs Lab

Page 3: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

http://www.compoundchem.com/wp-content/uploads/2014/09/A-Guide-to-Different-Classes-of-Antibiotics-Aug-15.png

@SiouxsieW

Page 4: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

http://www.biomedcentral.com/content/figures/1741-7007-8-123-1-l.jpgAntibiotic targets and mechanisms of resistance. Wright BMC Biology 2010 8:123 doi:10.1186/1741-7007-8-123

Broad vs narrow spectrum

Bactericidal vs bacteriostatic

@SiouxsieW

Page 5: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

http://www.biomedcentral.com/content/figures/1741-7007-8-123-1-l.jpgAntibiotic targets and mechanisms of resistance. Wright BMC Biology 2010 8:123 doi:10.1186/1741-7007-8-123

@SiouxsieW

Page 6: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

https://vimeo.com/180908160

@baym

@SiouxsieW

Page 7: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Mutation

Rates differ between species

Can be influenced by external factors/environment

@SiouxsieW

Page 8: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Transformation

http://cnx.org/contents/[email protected]:rZudN6XP@2/Introductionhttps://commons.wikimedia.org/w/index.php?curid=49931304

@SiouxsieW

Taking up genetic material from their

environment, e.g. plasmids

Page 9: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Transduction

@SiouxsieW

http://cnx.org/contents/[email protected]:rZudN6XP@2/Introductionhttps://commons.wikimedia.org/w/index.php?curid=49931304

Receiving genetic material after

infection with a virus

Page 10: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Conjugation

@SiouxsieW

http://cnx.org/contents/[email protected]:rZudN6XP@2/Introductionhttps://commons.wikimedia.org/w/index.php?curid=49931304

Transfer of genetic material between

bacterial cells of same or different

species by direct cell-to-cell contact.

Page 11: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Horizontal gene transfer

Differs between species

Can be influenced by external factors/environment

@SiouxsieW

Page 12: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

http://www.newshub.co.nz/home/health/2018/02/superbug-infects-national-burns-centre-patients.html

@SiouxsieW

Page 13: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Patient number

Species ResistanceSpecimen

dateLikely place of acquisition

35

K. pneumoniae NDM-1 5 Jan

Tahitian hospital

P. aeruginosa NDM-1 9 Jan

37

P. stuartii NDM-1 2 Jan

Middlemore Hospital

K. pneumoniae NDM-1 5 Jan

K. oxytoca NDM-1 5 Jan

E. coli NDM-1 5 Jan

E. cloacae complex

NDM-1 12 Jan

39 E. coli OXA-48 12 Jan Middlemore Hospital?

@SiouxsieW

Page 14: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

@SiouxsieW

Page 15: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Myth 3

It’s us that become

resistant to antibiotics

http://www.mightyearth.org/wp-content/uploads/2016/10/CHANGING-MARKET-SUPERBUGS-IN-THE-SUPPLY-CHAIN-GUARD-FONT-FIN-PRINT.pdf

@SiouxsieW

Page 16: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

@SiouxsieW

Page 17: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

http://bwb.co.nz/books/antibiotic-resistance

@SiouxsieW

Page 18: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Solutions?

18

@SiouxsieW

Page 19: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

@SiouxsieW

Page 20: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Wise use of existing

antibiotics

Vaccines & other

preventative measures

New antibiotics &

vaccines

Tackle infectious diseases

rates

@SiouxsieW

Page 21: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

https://www.health.govt.nz/system/files/documents/publications/new-zealand-antimicrobial-resistance-action-plan.pdf

@SiouxsieW

Page 22: Associate Professor - GP CME north/Sat_Room1_1403_Wiles.pdf · K. pneumoniae NDM-1 5 Jan Tahitian hospital P. aeruginosa NDM-1 9 Jan 37 P. stuartii NDM-1 2 Jan Middlemore Hospital

Medical professionals

Consumers Citizens

@SiouxsieW