anti- microbial resistance in egypt: a review

What doesn’t kill you, makes you stronger.

- Quote by a Resistant microbe

,,

under supervision ofProfessor Dr. Heba Abdel-Aaty

Head of parasitology department MUST College of Medicine

Presented by:Hatem Refaat El-Sheemy

Undergraduate MBBSMUST College of Medicine

Resistance.. What is the solution?

2nd Medical Integrated Students, Research (MISR) Conference


Aim of the Work

• 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.

WHO Definition

It’s when microorganisms

change when exposed to

antimicrobial drugs



Started From Here

Then…



Mechanism

Betty C. Jung diagrams


Causes of AMR Development


And another causes are..

Give me some antibiotics

The earlier, the better


Antimicrobials Abuse Life cycle

Ahram Canadian Univ. Campaign


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


Cold VS Flu

Aren’t we developing new antibiotics Why there is a problem?

But…


Discovery VS Resistance


Prevalence of Carbapenem -R

Laxminaryan R. et al 2014


Epidemiology: Europe


With the same rhythm.. This will be 2050

Epidemiology: Future,,,


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

acid21% (18) Reported

administrating antibiotics to their

children

SelfMedication

MR. El Hawty et al 2016


Most common indication

M. Talaat et al 2016


Most common indication

Human Case50% Believed that common diseases don’t worth

consulting

Where,

M. Talaat et al 2016


Epidemiology in Egypt

MO Ibrahim et al 2012


Antibiotic Misuse rate

MO Ibrahim et al 2012


Epidemiology: Egypt

M Talaat et al 2016


Source of MRSA st rains

Hospital Acquired Infection

Community Acquired Infection

183448

MRSA?MRSA? 34321

Out of 631 Staph. Aureus sample isolated during study period (2005 -2013)

Abdel Maksoud M. et al 2016





183448

MRSA?MRSA? 34321


2005: 48.6%2013: 86.6%

Moreover,

Abdel Maksoud M. et al 2016





183448

MRSA?MRSA? 34321


2005: 48.6%2013: 86.6%

Moreover,

Occurrence of Multi-Drug resistance

48.6% 85.8% Abdel Maksoud M. et al 2016


Everywhere!!

What is the case in Parasitology?

Reports ofAnti helminthic

Resistance


Resistance is now reported for

PraziquantelMetronidzole

Triclabendazole

AlbendazoleAnti-Malarial

Drugs


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 TCBZAnd Thus, development of Triclabendazole

resistance


Animal Resistant cases reported


Human Resistant cases reported

Gil, L.C. et al. (2014)

. Winkelhagen, A.J.S. et al. (2012)

71y Livestock FarmerMultiple TCBZ dose failure (2007-2010)The patient remains asymptomatic but infected.

4 Cases Between 2011-2013 with follow-upMultiple TCBZ dose failure

NL

ChileGil, L.C. et al. (2014)

1st


Human Resistant cases reported

Cabada et al. (2016)

Peru7 of 19 F.hepatica Cases Between January 2014 and April 2015Multiple TCBZ dose failure

Gülhan, B. et al. (2015)

9-year-old girl Multiple TCBZ dose failure + othersunderwent right hepatectomy.

Turkey


Current research efforts

TCBZ double

dose

AntihelminthicVaccine

New

TCBZ single dose Resistance


Other route.. New agents?

FlukicideRoute of

administration

Age of Fasciola hepatica

stage

Reports of resistance on farm

Albendazole Oral Adult 3 Cases

ClorsulonInjectable, 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


Other route.. Vaccine?

Leuicine Amino-peptidase

(89% in sheep)

Total Cathepsin L(69% in Cattle)

Fatty acid binding protein(55% in Cattle)

No commercial vaccine

So, Seriously…What is the solution now?


Integrated Approach?


Kelly J et al 2016 Approach


27th ESC Conference


General Approaches for AMR 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.


General Approaches for AMR 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


Limitations for 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.


Take Home messageCombat Resistance

Thank You All

[email protected]

Resistance... What is the solution?(( ))

2nd

anti- microbial resistance in egypt: a review

Healthcare