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Fig. 12.15a
Fig. 12.15b
Fig. 12.15c
Medical Microbiology
Methods for susceptibility testing should be:
reproducible
robust
reliable
Breakpoint concentrations
Qualitative
Susceptible
resistant
intermediate
Enzyme testing
B-lactamase
Synergism and antagonism
Medical Microbiology
Disc testing methods
cheap
flexible
visible
fiddly
CDS
NCCLS
Stokes
Fig. 12.18a
Fig. 12.18b
Fig. 12.18c
Medical Microbiology
Minimum inhibitory concentration (MIC)
Dilution testing:
agar
broth
E test
Antibacterial Agents
Classified according to:
Bactericidal or bacteriostatic
Target site
Chemical structure
Glycopeptides
Vancomycins
Tetracyclines
Inhibit RNA from entering acceptor sites on ribosomes
Chloroamphenicol
Prevents protein bond synthesis
Macrolides
Erythromycin, lincomycin, clindamycin
Rifamycin (rifampicin)
Blocks RNA synthesis
Resistance
Not inhibited or killed by an antibacterial agent, at
concentrations that can be achieved in the body.
Some bacteria can be innately resistant due to
cell wall structure or lack of target site.
Genetics of Resistance
Chromosomal mutation
Single mutations
Series of mutations
Transmissible plasmids
R plasmids
Jumping genes
Transposons
Mechanisms of
Resistance
Target site may be altered
Lower affinity for the drug
Altered uptake
Decreasing the permeability of the cell wall
Pumping the drug out of the cell
Enzyme production
Active against the drug
Betalactamase
Fig. 12.17