Resistance challenges in veterinary medicine: Who's to blame for "superbugs" and how do we deal with them (Proceedings)
Aug 01, 2010
CVC IN KANSAS CITY PROCEEDINGS
This presentation attempts to summarize some of the major concerns in resistance development along with key articles explaining relevance, epidemiology, and prevalence. It is not intended to be an exhaustive review of the literature and the interested practitioner should use the cited literature herein as a basis for continued, extended reading.
I. So where do these things come from? Here is the basic questions.
• Do resistant organisms develop from spontaneous mutations in your patient (or a population of patients, such as in some food animal applications) during antimicrobial use and then proliferate within the favorable climate of antimicrobial selection pressure?
Another very basic concept is that selection for a resistant pathogen or bacteria may be due to an entirely different selection pressure than the antimicrobial in which we happen to be interested. Multiple-drug resistance mechanisms allow co-selection for resistance traits; and, it doesn't even have to be an antimicrobial in the way we typically think of them. Co-selection by environmental disinfectants can co-select for antimicrobial resistance, as demonstrated for pine oil for E. coli, and triclosan for Pseudomonas aeruginosa. The presence of pathogens such as Vancomycin-Resistant Enterococci (VRE), Pseudomonas, and Methicillin-Resistant Staphylococcus aureus (MRSA) on surfaces, pagers, and stethoscopes has been well documented in human studies.
We don't cause the original spontaneous mutations. But, once these mutations take hold in an environment, we are responsible for aiding in selection and spread. As Pogo said, "We have met the enemy and he is us".
II. What are the challenges on the human side of medicine?
As many as 16% of all HAIs in this report were associated with the following multidrug-resistant pathogens.