WHAT YOUR STUDENTS NEED TO
KNOW
“Bacteria, Antibiotics
and
Antibiotic Resistance”
DACTM/MDSTA Joint Fall Conference
November 26, 2013
Woodhaven High School
Woodhaven, Michigan
ANTIBIOTIC RESISTANT THREATS IN THE UNITED STATES, 2013
A Report by
The Centers for Disease Control and Prevention
• Report issued on September 16, 2013 using
limited data collected from a variety of CDC
programs and data from at least 10 states
• “Threats” were assessed according to seven
factors related to resistant infections:
– Health impact
– Economic impact
– How common the infection is
Antibiotics Resistant Threats in the United States, 2013
(cont.)
– 10-year projection of how common it will become
– How easily it spreads
– Availability of effective antibiotics
– Barriers to prevention
Antibiotics Resistant Threats in the United States, 2013
(cont.)
• Infections classified as urgent include:
– Carbapenem-resistant enterbacteriaceae
– Drug-resistant gonorrhea, and
– Clostridium difficile
Antibiotics Resistant Threats in the United States, 2013
(cont.)
Key points to know:
1. Each year more than 2 million people in the
U.S. get infections that are resistant to
antibiotics and at least 23,000 people die.
2. C.difficile, usually associated with antibiotic
use in hospitalized patients cause nearly
250,000 additional hospitalizations per year
and result in over 14,000 deaths
Antibiotics Resistant Threats in the United States, 2013
(cont.)
3. Patients with resistant infections are at
higher risk of disability and death
4. Total economic cost of antibiotic
resistance in the U.S. may be as high as
$20 billion with additional loss of worker
productivity resulting in a loss as high as
$35 billion
5. Antibiotics are among the most commonly
prescribed drugs, estimated that up to 50%
Antibiotics Resistant Threats in the United States, 2013
(cont.)
5. (cont). of all antibiotics prescribed are not
needed or not prescribed appropriately
6. As in humans, antibiotics should only be
used in food animals to manage infections;
not to promote growth or as a prophylactic
Antibiotics Resistant Threats in the United States, 2013
(cont.)
WHAT NEEDS TO BE DONE NOW
• Rapid research and development of new
antibiotics and anti-fungals
• Increase collection of comprehensive data
• Provide education about antibiotic resistance
prevention and promote antibiotic
stewardship
Four core actions are needed
• Prevent infections whenever possible
• Track data on antibiotic-resistant infections,
causes, and risk factors
• Improve antibiotic stewardship – use targeted
antibiotics whenever possible rather than broad
spectrum drugs, use of regional antibiogram by
primary care physicians
• Development of new antibiotics and diagnostic
tests to track the development of resistance
ANTIBIOTIC RESISTANCE
10
National Antibiotic Prescribing
CDC Abstract, 10/22/2010
11
What is the MARR Coalition?
• The Michigan Antibiotic Resistance Reduction
(MARR) Coalition is a multi-stakeholder, nonprofit organization
• Supported by an annual, competitive grant from
the CDC “Get Smart – Know When Antibiotics
Work in the Community”
• The MARR Mission is to:
• Encourage appropriate use of antimicrobial agents
• Reduce antimicrobial resistance rates through diverse collaboration in
the public and professional communities
• Promote appropriate use of antibiotics through educational programs
and interventions
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Community Education
Let’s make
it fun!
• “Antibiotics and You” presentation for
elementary students and adults
• “High School Biology/Health” curriculum
• Consumer education materials (“Antibiotics: What You
Should Know” and “MRSA”, posters, fact sheets, FAQs)
• MARR website: www.reducemisuse.org
• Booths and Exhibits
• “GET SMART” Antibiotics Awareness Week
• Legislative education
• Community speaking engagements
© MARR Coalition 2013
H.S. Curriculum Content
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MICHIGAN AND OREGON
PROGRAMS COLLABORATE
High School Curriculum Project
•
•
What Tools Are Provided for Teachers?
Developed by professional in state
community health and education
departments with the help of science
teachers, physicians, nurses,
pharmacists, and microbiologists
Pre-packaged two-day curriculum
modules:
– Viruses and bacteria,
– How antibiotics work
– Development of antibiotic
resistance
– Environmental/Global impact
© MARR Coalition 2013
H.S. Curriculum Content
•
•
•
•
•
•
•
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Materials on MARR website @:
www.reducemisuse.org
Instructional video for teacher
PowerPoint presentations for
students
Pre and posttest for students
Worksheet for students
Resource information for interactive
activities
Report/evaluation
PILOT OF CURRICULUM IN A MICHIGAN
MATH AND SCIENCE CENTER
•
•
•
•
Pilot with 11th and 12th graders
Pre- and Post-test given
Students knew most material in Module I
Higher percentage of students did not know:
–
–
–
–
–
–
–
How bacteria can be beneficial to the body
Body’s defenses to preventing bacteria from entering
What an antibiotic is and how it works
What is antibiotic resistance
How bacteria mutate
What is selective pressure
How antibiotics can be acquired through the environment
© MARR Coalition 2013
H.S. Curriculum Content
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MICHIGAN SCIENCE CONTENT STANDARDS
AND EXPECTATIONS – “BIOLOGY”
• Scientific Reflection and Social Implications – B1.2
• Organization and Development of Living Systems
– L2.p2, L2.p3, B2.1,B2.4, B2.4h, B2.4i
• Interdependence of Living Systems and the
Environment – L3.p1, L3.p2A, L3.p2B, L3.p2D,
L3.p4A
• Evolution and Biodiversity – L5.p1, B5.1A,
B5.1cB B5.1c, B5.1d, B5.3g, B5.3A, B5.3f
© MARR Coalition 2013
H.S. Curriculum Content
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HOW DO I ACCESS THE
CURRICULUM?
•
•
•
•
•
Go to the MARR website at: reducemisuse.org
Click on: presenter/educator
Click to go to Download Center
Complete Registration Page
Click your desired curriculum
– “High School Biology/Health” curriculum
– “Antibiotics and You”, elementary curriculum
High School Biology/Health Curriculum
for
9th and 10th grade students
VIRUSES AND BACTERIA, ANTIBIOTIC
DEVELOPMENT, AND ANTIBIOTIC
RESISTANCE
HIGHLIGHTS
© MARR Coalition 2013
H.S. Curriculum Content
Module One: What We Will Learn
• What are microbes?
• What are viruses?
• What are bacteria?
– Structure
– Where do they live?
• Bacteria and humans
–
–
–
–
Bacterial identification
Colonization
Host cell defenses
How bacteria cause infection
© MARR Coalition 2013
H.S. Curriculum Content
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Module Two: What We Will Learn
• Antibiotics
– How they work
– How bacteria become resistant
• Mutations in bacterial genes
• Selection pressure (evolution)
• Exchange of genetic material between bacteria
• Strategies for overcoming antibiotic resistance in bacteria
– Appropriate use
– Research and development of new antibiotics
© MARR Coalition 2013
H.S. Curriculum Content
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Influenza Virus Structure
N spike
(neuraminidase)
Lipid Envelope
Matrix protein
Nucleocapsid
H spike
(hemagglutinin)
RNA
© MARR Coalition 2013
2011222H.S. Curriculum Content
Copyright © motifolio.com
Viruses Invade Host Cells
• Viruses lack some of the machinery to grow and
reproduce by themselves
• A virus invades a live host cell inside your body
and starts replicating itself
• The host cell releases the copied viruses
• Each released virus will look for a new live host
cell to invade and repeat the process
Virus infecting a cell
© MARR Coalition 2013
H.S. Curriculum Content
Example of Bacterial Structure
Cell (Cytoplasmic) membrane
Ribosomes
Pili
Cell wall
Flagella
Plasmids
Chromosome
© MARR Coalition 2013
2711102 H.S. Curriculum Content
Copyright © motifolio.com
Today
Antibiotic Timeline
Some
antibiotics
don’t work
anymore
Way B.C.
Bacteria were
around before
the dinosaurs
Millions of
years later
1920s
1940s
President’s
son dies
from a
bacterial
infection
The first
antibiotics
are made
for humans
1950s
Antibiotic resistance
starts becoming
a problem
2000s
2030
You are
born!
Will we
have
antibiotics that
work?
?
© MARR Coalition 2013
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What is an Antibiotic?
• A chemical that
kills bacteria or
stops
them from growing
• Antibiotics work
only against
bacteria, not
viruses
© MARR Coalition 2013
H.S. Curriculum Content
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Selecting the Right Antibiotic
For the Bacterial Infection
*Bacteria are resistant
to this antibiotic.
• Bacteria grown in the lab are
swabbed onto the surface of an agar
culture plate
• Filter paper disks containing different
antibiotics are placed on the surface
of the agar plate
• The agar plate is incubated at body
temperature overnight
• An effective antibiotic is shown by a
“clear zone” on the agar plate where
the bacteria were inhibited
Antibiotic
by the antibiotic as it
Bacteria from tissue
diffused out from the *The “clear zone” around various antibiotics or fluid sample
on this agar plate mean that these bacteria are
disk
susceptible to these various antibiotics..
© MARR Coalition 2013
H.S. Curriculum Content
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I’M A
LOCK!
How Antibiotics Work
If you think of bacteria as a lock, then an
antibiotic is like a key
© MARR Coalition 2013
H.S. Curriculum Content
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I’M A
KEY!
Bacterial Lock and Antibiotic Key
• Four things can happen:
– The antibiotic key can unlock the bacteria and kill them
– The antibiotic key can become damaged so it cannot open the
bacterial lock
– The bacterial lock can make slight changes so the key (antibiotic)
no longer fits in the lock
– The bacterial keyhole can become blocked so the antibiotic can
not enter
© MARR Coalition 2013
H.S. Curriculum Content
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How Do Antibiotics Fight Bacteria?
• Antibiotics disrupt a specific function of a bacterium,
preventing its growth and replication by:
– interfering with DNA or RNA replication
– disrupting the production of the bacterial cell wall
– preventing the production of proteins and smaller molecules that
are necessary for growth and replication
– Dissolving the cell membrane, causing leakage of cytoplasmic
contents
© MARR Coalition 2013
H.S. Curriculum Content
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Key Concepts to Remember About
Antibiotics
• A newly developed antibiotic is most effective when it is first
released for human treatment, since later use will inevitably
select resistant bacteria
• Today some bacteria have developed multidrug resistance, and,
in some cases, bacteria are resistant to all available antibiotics
• Over time, even fewer antibiotics will be effective, unless
newer ones can be developed to replace them
• The development of new antibiotics has slowed, primarily due
to development cost and lower financial incentive, since the
income from an antibiotics taken for 10 days is less than from
drugs that are prescribed for lifetime use (e.g.,
antihypertensive drugs, cholesterol-lowering drugs)
© MARR Coalition 2013
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How Does Resistance Develop?
I.
Mutations in resistance genes in bacteria
II. Transfer of genetic material from resistant bacteria to
susceptible bacteria
III. Selective pressure (the preservation of resistant cells
while susceptible cells are killed (e.g., evolution)
© MARR Coalition 2013
H.S. Curriculum Content
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Selective Pressure
• The presence of an antibiotic selects the growth of an
organism that has become resistant by mutation or
acquiring new DNA.
• Mechanisms include:
– Patient non-compliance (only taking for a few days or skipping doses)
– Inadequate dosing (dose to low, or doses spaced too far apart)
– Misuse of antibiotics
 Overuse (prescribing when not needed)
 Inappropriate use (patient taking antibiotics prescribed for a different infection)
 Unnecessary use of broad-spectrum antibiotic (exposing patient to a drug that can
affect colonizing bacteria elsewhere in the body)
© MARR Coalition 2013
H.S. Curriculum Content
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Selection for Resistance
Sensitive and resistant
bacteria live together.
© MARR Coalition 2013
H.S. Curriculum Content
Antibiotics kill sensitive
bacteria.
The resistant bacteria are
left to multiply.
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Important Things to Remember
About Antibiotics
Bacteria
Viruses
• Antibiotics kill bacteria, not viruses.
XX
• Taking an antibiotic unnecessarily
for colds and flu can select bacteria
in the body that are resistant to
Does not
the antibiotic.
work
Antibiotics
• Never save or share your antibiotics.
• Take your antibiotics as prescribed by your care provider.
© MARR Coalition 2013
H.S. Curriculum Content
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Why Should We Be Concerned
About Antibiotic Resistance?
• Antibiotic resistance is a serious global problem
• Resistant infections are difficult to treat –
the bacteria may be resistant to multiple
types of antibiotics
• Resistance limits the range of effective antibiotics,
sometimes leaving only antibiotics that are expensive,
inconvenient to use, or even dangerous (toxic)
© MARR Coalition 2013
H.S. Curriculum Content
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Additional Environmental Concerns
• Antibiotics are being used to treat meat animals and poultry to
prevent infections rather than to treat them, and to promote faster
growth; this excessive antibiotic usage can lead to selection of
antibiotic resistant bacteria which can get into humans, either from
close contact or consumption of infected meat or dairy products
• Improper disposal of old or unused antibiotics can pollute the water
supply, exposing the general public to low levels of antibiotics which
can select for resistance in colonizing bacteria
© MARR Coalition 2013
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Preventing Bacterial Infection
is the Best Medicine!
• Wash your hands properly
– Before eating
– After using the bathroom
– After a sneeze or cough
• Cover coughs and sneezes
• Help your immune system by:
– Eating healthy foods
– Exercising regularly
– Getting plenty of sleep every night
• NEVER take an antibiotic for
a viral infection, like a cold or flu
© MARR Coalition 2013
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What Else Can You Do?
• If you are prescribed antibiotics, take all of the medication
as prescribed by your care provider
• Do not stop taking an antibiotic before the end of the
treatment course just because you start to feel better;
residual bacteria may multiply, causing recurrence of
symptoms that may require retreatment increasing the
likelihood of selecting resistant cells
• Never share or save antibiotics
• Spread the word, not the resistance
© MARR Coalition 2013
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WHAT MARR HOPES TO ACHIEVE
THROUGH EDUCATIONAL CURRICULUM
• An applicable knowledge for students about the
seriousness of antibiotic resistance
– How bacteria is spread
– How it is treated
– Why it is important to take antibiotics only when and as
prescribed by a professional
– What is antibiotic resistance
• How to preserve antibiotics for the future
© MARR Coalition 2013
H.S. Curriculum Content
High School Biology/Health and
Elementary School Curriculum
Now Available
Download at: www.reducemisuse.org
For More Information
Contact: Jane Finn, MARR Executive Director
517-664-5263
jane@mi-marr.org
© MARR Coalition 2013
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