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What doesn’t kill you,
makes you stronger.
- Quote by a Resistant microbe
,,
under supervision of
Professor Dr. Heba Abdel-Aaty
Head of parasitology department
MUST College of Medicine
Presented by:
...
2nd Medical Integrated Students, Research (MISR) Conference
Aim of theWork
• Review of Current state of AMR
(Anti-microbia...
WHO Definition
It’s when microorganisms
change when exposed to
antimicrobial drugs
2nd Medical Integrated Students, Resear...
2nd Medical Integrated Students, Research (MISR) Conference2nd Medical Integrated Students, Research (MISR) Conference
2nd Medical Integrated Students, Research (MISR) Conference
Mechanism
Betty C. Jung diagrams
2nd Medical Integrated Students, Research (MISR) Conference
Mechanism
Betty C. Jung diagrams
2nd Medical Integrated Students, Research (MISR) Conference
Causes of AMR Development
2nd Medical Integrated Students, Research (MISR) Conference
And another causes are..
2nd Medical Integrated Students, Research (MISR) Conference
Antimicrobials Abuse Life cycle
Ahram Canadian Univ. Campaign
2nd Medical Integrated Students, Research (MISR) Conference
Time for some WHO numbers
• Up to half of antibiotics used
in ...
2nd Medical Integrated Students, Research (MISR) Conference
Cold VS Flu
2nd Medical Integrated Students, Research (MISR) Conference
Cold VS Flu
2nd Medical Integrated Students, Research (MISR) Conference
Cold VS Flu
Aren’t we developing new antibioticsWhy there is a problem?
Aren’t we developing new antibioticsWhy there is a problem?
2nd Medical Integrated Students, Research (MISR) Conference
Discovery VS Resistance
2nd Medical Integrated Students, Research (MISR) Conference
Prevalence ofCarbapenem-R
Laxminaryan R. et al 2014
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology: Europe
2nd Medical Integrated Students, Research (MISR) Conference
With the same rhythm.. This will be 2050
Epidemiology: Future,...
2nd Medical Integrated Students, Research (MISR) Conference
Egyptians and AMR
64% (231) Used antibiotics last 12m
without ...
2nd Medical Integrated Students, Research (MISR) Conference
Most common indication
M. Talaat et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Most common indication
Human Case
50% Believed that common dis...
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology inEgypt
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology inEgypt
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
AntibioticMisuse rate
MO Ibrahim et al 2012
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology: Egypt
M Talaat et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Epidemiology: Egypt
M Talaat et al 2016
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Source of MRSA strains
Hospital
Acquired
Infection
Community
A...
2nd Medical Integrated Students, Research (MISR) Conference
Everywhere!!
What is the case in
Parasitology?
Reports of
Anti helminthic Resistance
2nd Medical Integrated Students, Research (MISR) Conference
Resistance is now reported for
Praziquantel
Metronidzole
Tricl...
2nd Medical Integrated Students, Research (MISR) Conference
Triclabendazole for fascioliasis
• Benzimidazole derivative
• ...
2nd Medical Integrated Students, Research (MISR) Conference
Animal Resistantcases reported
2nd Medical Integrated Students, Research (MISR) Conference
Human Resistant casesreported
Gil, L.C. et al. (2014)
. Winkel...
2nd Medical Integrated Students, Research (MISR) Conference
Human Resistant casesreported
Cabada et al. (2016)
Peru
7 of 1...
2nd Medical Integrated Students, Research (MISR) Conference
Current research efforts
TCBZ single dose Resistance
2nd Medical Integrated Students, Research (MISR) Conference
Other route.. New agents?
Flukicide
Route of
administration
Ag...
2nd Medical Integrated Students, Research (MISR) Conference
Other route.. Vaccine?
Leuicine Amino-peptidase
(89% in sheep)...
2nd Medical Integrated Students, Research (MISR) Conference
IntegratedApproach?
2nd Medical Integrated Students, Research (MISR) Conference
KellyJ et al 2016 Approach
2nd Medical Integrated Students, Research (MISR) Conference
27th ESC Conference
2nd Medical Integrated Students, Research (MISR) Conference
General ApproachesforAMR Control
• Common Cold DOESNOT NEED An...
2nd Medical Integrated Students, Research (MISR) Conference
General ApproachesforAMR Control
• Common Cold DOESNOT NEED An...
2nd Medical Integrated Students, Research (MISR) Conference
General ApproachesforAMR Control
• Common Cold DOESNOT NEED An...
2nd Medical Integrated Students, Research (MISR) Conference
Limitationsfor project
• Need for more national wide studies
a...
2nd Medical Integrated Students, Research (MISR) Conference
Take Home message
Thank You All
Hatem45132@student.must.edu.eg
Resistance...
What is the solution?(( ))
2nd
Anti- Microbial Resistance in Egypt: a review
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Anti- Microbial Resistance in Egypt: a review

This is part of our project that aims to assess current state of anti-microbial resistance in Egypt with a specific focus on development of anti-parasitic drugs resistance in addition.

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Anti- Microbial Resistance in Egypt: a review

  1. 1. What doesn’t kill you, makes you stronger. - Quote by a Resistant microbe ,,
  2. 2. under supervision of Professor Dr. Heba Abdel-Aaty Head of parasitology department MUST College of Medicine Presented by: Hatem Refaat El-Sheemy Undergraduate MBBS MUST College of Medicine Resistance.. What is the solution? 2nd Medical Integrated Students, Research (MISR) Conference
  3. 3. 2nd Medical Integrated Students, Research (MISR) Conference Aim of theWork • Review of Current state of AMR (Anti-microbial resistance) in Egypt • Review of Triclabendazole resistance as an example of resistance against anti-parasitic drugs. • Review of current approaches for control of AMR and APR.
  4. 4. WHO Definition It’s when microorganisms change when exposed to antimicrobial drugs 2nd Medical Integrated Students, Research (MISR) Conference
  5. 5. 2nd Medical Integrated Students, Research (MISR) Conference2nd Medical Integrated Students, Research (MISR) Conference
  6. 6. 2nd Medical Integrated Students, Research (MISR) Conference Mechanism Betty C. Jung diagrams
  7. 7. 2nd Medical Integrated Students, Research (MISR) Conference Mechanism Betty C. Jung diagrams
  8. 8. 2nd Medical Integrated Students, Research (MISR) Conference Causes of AMR Development
  9. 9. 2nd Medical Integrated Students, Research (MISR) Conference And another causes are..
  10. 10. 2nd Medical Integrated Students, Research (MISR) Conference Antimicrobials Abuse Life cycle Ahram Canadian Univ. Campaign
  11. 11. 2nd Medical Integrated Students, Research (MISR) Conference Time for some WHO numbers • Up to half of antibiotics used in humans are unnecessary and inappropriate. • the common cold is the most common reason antibiotics are prescribed. • For example, a third of people believe that antibiotics are effective for common cold • 60% of people understand effect of AMR on them and their families but don’t understand why it occurs • Antiseptics are still under investigation either effective or not in reducing infection rate and causing AMR. WHO 2015 Report
  12. 12. 2nd Medical Integrated Students, Research (MISR) Conference Cold VS Flu
  13. 13. 2nd Medical Integrated Students, Research (MISR) Conference Cold VS Flu
  14. 14. 2nd Medical Integrated Students, Research (MISR) Conference Cold VS Flu
  15. 15. Aren’t we developing new antibioticsWhy there is a problem?
  16. 16. Aren’t we developing new antibioticsWhy there is a problem?
  17. 17. 2nd Medical Integrated Students, Research (MISR) Conference Discovery VS Resistance
  18. 18. 2nd Medical Integrated Students, Research (MISR) Conference Prevalence ofCarbapenem-R Laxminaryan R. et al 2014
  19. 19. 2nd Medical Integrated Students, Research (MISR) Conference Epidemiology: Europe
  20. 20. 2nd Medical Integrated Students, Research (MISR) Conference With the same rhythm.. This will be 2050 Epidemiology: Future,,,
  21. 21. 2nd Medical Integrated Students, Research (MISR) Conference Egyptians and AMR 64% (231) Used antibiotics last 12m without prescription 47% (109) Main reason was to save time and effort 60% (212) Most Used antibiotic: Amoxicillin – clavulanic acid 21% (18) Reported administrating antibiotics to their children MR. El Hawty et al 2016
  22. 22. 2nd Medical Integrated Students, Research (MISR) Conference Most common indication M. Talaat et al 2016
  23. 23. 2nd Medical Integrated Students, Research (MISR) Conference Most common indication Human Case 50% Believed that common diseases don’t worth consulting M. Talaat et al 2016
  24. 24. 2nd Medical Integrated Students, Research (MISR) Conference Epidemiology inEgypt MO Ibrahim et al 2012
  25. 25. 2nd Medical Integrated Students, Research (MISR) Conference Epidemiology inEgypt MO Ibrahim et al 2012
  26. 26. 2nd Medical Integrated Students, Research (MISR) Conference AntibioticMisuse rate MO Ibrahim et al 2012
  27. 27. 2nd Medical Integrated Students, Research (MISR) Conference Epidemiology: Egypt M Talaat et al 2016
  28. 28. 2nd Medical Integrated Students, Research (MISR) Conference Epidemiology: Egypt M Talaat et al 2016
  29. 29. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) Abdel Maksoud M. et al 2016
  30. 30. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) 2005: 48.6% 2013: 86.6% Moreover, Abdel Maksoud M. et al 2016
  31. 31. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) 2005: 48.6% 2013: 86.6% Moreover, Occurrence of Multi-Drug resistance 48.6% 85.8% Abdel Maksoud M. et al 2016
  32. 32. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) 2005: 48.6% 2013: 86.6% Moreover, Occurrence of Multi-Drug resistance 48.6% 85.8% Abdel Maksoud M. et al 2016
  33. 33. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) 2005: 48.6% 2013: 86.6% Moreover, Occurrence of Multi-Drug resistance 48.6% 85.8% Abdel Maksoud M. et al 2016
  34. 34. 2nd Medical Integrated Students, Research (MISR) Conference Source of MRSA strains Hospital Acquired Infection Community Acquired Infection 183 448 MRSA?MRSA? 34321 Out of 631 Staph. Aureus sample isolated during study period (2005 -2013) 2005: 48.6% 2013: 86.6% Moreover, Occurrence of Multi-Drug resistance 48.6% 85.8% Abdel Maksoud M. et al 2016
  35. 35. 2nd Medical Integrated Students, Research (MISR) Conference Everywhere!!
  36. 36. What is the case in Parasitology? Reports of Anti helminthic Resistance
  37. 37. 2nd Medical Integrated Students, Research (MISR) Conference Resistance is now reported for Praziquantel Metronidzole Triclabendazole Albendazole Anti-Malarial Drugs
  38. 38. 2nd Medical Integrated Students, Research (MISR) Conference Triclabendazole for fascioliasis • Benzimidazole derivative • First introduced in 1980 • Drug of choice for both: 1- Animal and Human fascioliasis 2- Acute and Chronic infection. 3- Adult and immature stage of parasite. All these factors contributed in Over-Reliance on TCBZ And Thus, development of Triclabendazole resistance
  39. 39. 2nd Medical Integrated Students, Research (MISR) Conference Animal Resistantcases reported
  40. 40. 2nd Medical Integrated Students, Research (MISR) Conference Human Resistant casesreported Gil, L.C. et al. (2014) . Winkelhagen, A.J.S. et al. (2012) 71y Livestock Farmer Multiple TCBZ dose failure (2007-2010) The patient remains asymptomatic but infected. 4 Cases Between 2011-2013 with follow-up Multiple TCBZ dose failure NL Chile Gil, L.C. et al. (2014) 1st
  41. 41. 2nd Medical Integrated Students, Research (MISR) Conference Human Resistant casesreported Cabada et al. (2016) Peru 7 of 19 F.hepatica Cases Between January 2014 and April 2015 Multiple TCBZ dose failure Gülhan, B. et al. (2015) 9-year-old girl Multiple TCBZ dose failure + others underwent right hepatectomy.Turkey
  42. 42. 2nd Medical Integrated Students, Research (MISR) Conference Current research efforts TCBZ single dose Resistance
  43. 43. 2nd Medical Integrated Students, Research (MISR) Conference Other route.. New agents? Flukicide Route of administration Age of Fasciola hepatica stage Reports of resistance on farm Albendazole Oral Adult 3 Cases Clorsulon Injectable, Oral Adult, late immature respectively 3 cases Closantel Pour-on, injectable, oral late immature 1 case Nitroxynil Injectable Adult 1 case Nitroxynil + clorsulon Injectable early immature No reports to date Oxyclozanide Oral Adult No reports to date
  44. 44. 2nd Medical Integrated Students, Research (MISR) Conference Other route.. Vaccine? Leuicine Amino-peptidase (89% in sheep) Total Cathepsin L (69% in Cattle) Fatty acid binding protein (55% in Cattle)
  45. 45. 2nd Medical Integrated Students, Research (MISR) Conference IntegratedApproach?
  46. 46. 2nd Medical Integrated Students, Research (MISR) Conference KellyJ et al 2016 Approach
  47. 47. 2nd Medical Integrated Students, Research (MISR) Conference 27th ESC Conference
  48. 48. 2nd Medical Integrated Students, Research (MISR) Conference General ApproachesforAMR Control • Common Cold DOESNOT NEED Antibiotics. • Work on community understanding that antibiotics over-use has its side effect. • Health care providers awareness of AMR • OCT Antibiotics prescription reduction.
  49. 49. 2nd Medical Integrated Students, Research (MISR) Conference General ApproachesforAMR Control • Common Cold DOESNOT NEED Antibiotics. • Work on community understanding that antibiotics over-use has its side effect. • Health care providers awareness of AMR • OCT Antibiotics prescription reduction.
  50. 50. 2nd Medical Integrated Students, Research (MISR) Conference General ApproachesforAMR Control • Common Cold DOESNOT NEED Antibiotics. • Work on community understanding that antibiotics over-use has its side effect. • Health care providers awareness of AMR • OCT Antibiotics prescription reduction. Some recent Approaches Used • Poster and media approach • Performance- reward approach • Antibiotic justification approach
  51. 51. 2nd Medical Integrated Students, Research (MISR) Conference Limitationsfor project • Need for more national wide studies about AMR and parasitic diseases in Egypt. • Many Thesis related to the topic were found with high sample size but aren’t yet published. • No specific guidelines are available for antihelminthic drugs administration.
  52. 52. 2nd Medical Integrated Students, Research (MISR) Conference Take Home message
  53. 53. Thank You All Hatem45132@student.must.edu.eg Resistance... What is the solution?(( )) 2nd

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