2. A review on evaluation of Antimicrobial Resistance
in Hospital-Acquired infection
Student Name
Muhammad Abdullah
Anmol Areej
BSMLS-F21-145
BSMLS-F21-135
Supervisor Name
Ijaz Ahmad
MS Biochemistry
Department of
Superior University Lahore
3. TABLE OF CONTENTS
1. INTRODUCTION
2. PROBLEM STATEMENT
3. OBJECTIVE (S)
4. METHODOLOGY
5. RESULTS
6. CONCLUSION
7. REFERENCES
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INTRODUCTION
•Antibiotic resistance (AR) is a global health threat.
•Misuse and overuse of antibiotics have accelerated AR.
•Bacteria develop mechanisms to survive antibiotic treatments.
•WHO recognizes AR as one of the top 10 global public health threats.
•AR leads to longer hospital stays, higher medical costs, and increased mortality.
•Common infections becoming harder to treat.
•Resistance is spreading faster than new antibiotics are being developed.
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•AR is prevalent in both hospital and community settings.
•Examples: MRSA, MDR-TB, and drug-resistant E. coli.
•Need for surveillance, antibiotic stewardship, and public awareness.
CONCLUSION
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PROBLEM STATEMENT
•Despite medical advances, AR continues to rise.
•Inadequate diagnostic practices and over-the-counter antibiotic
sales worsen the issue.
•Lack of new antibiotics and insufficient public knowledge
contribute to the crisis.
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OBJECTIVE
• To review the prevalence, common pathogens, resistance patterns, and risk factors of
antimicrobial resistance in hospital-acquired infections (HAIs) and recommend strategies
for enhancing infection control and antibiotic stewardship.
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METHODOLOGY
•Type of Study: Literature review and data analysis.
•Sources: Peer-reviewed journals, WHO reports, CDC data.
•Parameters Assessed: Resistance mechanisms, global prevalence,
intervention strategies.
•Tools Used: Qualitative analysis, statistical summaries from cited sources.
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RESULTS
•Significant rise in Multidrug-Resistant (MDR) bacteria globally.
•MRSA (Methicillin-resistant Staphylococcus aureus) and ESBL-
producing Enterobacteriaceae are among the most prevalent.
•Countries with high antibiotic misuse show higher resistance rates.
•Lack of diagnostic tools contributes to empirical (often incorrect) antibiotic
use.
•Resistance observed across beta-lactams, quinolones, and
aminoglycosides.
•Pseudomonas aeruginosa and Acinetobacter baumannii show resistance
even to last-resort drugs like carbapenems.
•Urban hospitals report higher AR due to patient load and cross-infection
risks.
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Impact of Antimicrobial Stewardship
•Hospitals with strict antibiotic stewardship programs saw a 25–40% reduction in resistant infections.
•Combination therapy more effective in reducing resistance emergence.
•Surveillance and routine resistance profiling improve patient outcomes.
RESULTS
Pathogen Resistance Profile Key Resistance Mechanisms
Acinetobacter baumannii 98% resistance to carbapenems, 94–98% to
cephalosporins
MBL, ESBL production
Pseudomonas aeruginosa 89% carbapenem resistance, 92.9% resistance to
ciprofloxacin
Efflux pumps, β-lactamase genes
Escherichia coli 70.8% prevalence in UTIs; 100% resistance to
ceftazidime, ampicillin
ESBL, mcr-1 gene (colistin resistance)
MRSA 100% resistance to β-lactams; emerging vancomycin
resistance
mecA gene, altered PBPs
Table 1: Resistance Profile of
Pathogens
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DISCUSSION
•Hospitals as High-Risk Zones:
Ironically, hospitals—especially in LMICs—are hotspots for Healthcare-Associated Infections (HAIs) due to
overcrowding, poor infection control, and antibiotic misuse.
•Prevalence & Impact:
Up to 25% of patients in LMIC hospitals develop HAIs, leading to:
•Prolonged hospital stays
•Increased healthcare costs
• Higher morbidity & mortality—especially in ICU, neonatal, and immunocompromised patients
•ESKAPE Pathogens:
These MDR superbugs are leading causes of HAIs and resist even last-resort antibiotics like carbapenems and
polymyxins.
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•Rise of Resistance:
•Carbapenem and polymyxin use rose by 34% and 14% (2000–2010).
•Resistance is driven by mobile genetic elements (e.g., plasmid-borne mcr genes).
•Bacterial Defense Tactics:
•LPS modification, efflux pumps, capsule formation, and protein overexpression fuel polymyxin
resistance.
•Colistin resistance has spread to 20+ countries—mainly via Gram-negative bacteria.
•Combat Strategy:
•Infection Prevention & Control (IPC): Hand hygiene, waste disposal, surveillance
•Antibiotic Stewardship: Use of narrow-spectrum drugs, short treatment durations, precise diagnostics
•Multidisciplinary Approach: Collaboration at individual, hospital, national, and global levels
DISCUSSION
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CONCLUSION
The hospital acquired infection burden is on the rise worldwide. The
persistent occurrence of antimicrobial resistant bacteria, especially
Gram-negative bacteria is adding to the HAIs challenge. The abundance
of innate resistance mechanisms and acquired genes exhibited by
Gram-negative bacteria further adds to the inefficiency of antibiotics,
particularly last-resort like polymyxins. Understanding the interaction of
HAIs and antimicrobial resistant Gram-negative bacteria may guide
effective infection control measures to facilitate implementation of
safety measures.
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LIMITATION AND FUTURE PERSPECTIVE
LIMITATION
•Lack of Primary Data
Study is based on literature review; no original clinical or lab data was collected.
•Regional Data Gaps
Limited data availability from developing countries and rural areas.
•Rapid Evolution
Bacterial resistance evolves quickly—findings may become outdated rapidly.
•Variability in Methodologies
Studies included used different diagnostic standards and definitions of resistance.
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Future Prospects
•Development of New Antibiotics
Encourage pharmaceutical innovation targeting MDR pathogens.
•Strengthen Surveillance
Establish global networks for real-time resistance tracking and data sharing.
•Antibiotic Stewardship Programs
Implement in all healthcare settings, including primary care and veterinary sectors.
•Public Awareness Campaigns
Educate about responsible antibiotic use at community and school levels.
•Alternative Therapies
Explore bacteriophage therapy, probiotics, and immunotherapies as complements to antibiotics.
LIMITATION AND FUTURE PERSPECTIVE
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REFERENCES
1:-World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva: World
Health Organization; 2014.
2:-Spellberg B, Powers JH, Brass EP, Miller LG, Edwards JE Jr. Trends in antimicrobial resistance among major
pathogens in the United States. Clin Infect Dis. 2004;38 Suppl 4:S101-8.
3:-Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance in India: drivers and opportunities for action.
BMJ. 2013;346:f3398.
4:-Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36(6):697-705.
5:-Hawkey PM, Jones AM. The changing epidemiology of resistance. J Antimicrob Chemother. 2009;64 Suppl
1:i3-i10.
6:-Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: what are the data?
Clin Infect Dis. 2006;42 Suppl 2:S82-9.
7:-Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst
nightmare? Clin Infect Dis. 2002;34(5):634-40.
8:-Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-
resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
Clin Microbiol Infect. 2012;18(3):268-81.
