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• “ Saved more lives by introduction of his system than all the wars of the 19th century together had sacrificed”
• Revolutionized surgery
Rate of Microbial Death
• Factors that influence effectiveness– # of microbes– Presence of organic material interferes with
action of disinfectant– Temperature– Time of exposure– Characteristic of organism
Potential Risk of Infection
• Critical items-direct contact with body tissues
• Semi critical- contact with mucous membranes but do not penetrate body tissue
• Non critical-contact with intact skin
Actions of Agents
• Damage to membrane-leakage
• Damage to proteins & nucleic acids– Enzymes– Nucleic acids -lethal
Physical Methods of Control
• Heat– Denatures enzymes
• Moist heat coagulates proteins– Boiling kills vegetative forms of pathogens
Autoclave
• Uses temperature above boiling water• Steam under pressure• Preferred method unless material is damaged• Higher the pressure, higher the temperature• Need direct contact with steam• All air is evacuated from chamber• 15 psi at 121 C for 15 mins
Autoclave
• Prions- protein only– 134 C for 18 mins– Soak in 1N NaOH for 1 hour
• Flash sterilization-at 134 C for 3min– Used for individual instruments
• Packaging
• Use of indicators– Biological indicators-endospores
Physical Methods of Control
• Pasteurization for heat sensitive products– Mild heating to kill pathogens
• Dry heat– Kills by oxidation– Flaming or hot air
Filtration
• Passage of liquid through screen device
• Pores small enough to retain microbes
• Sterilize heat sensitive materials
• Negative-uses vacuum
• Positive uses pressure
• HEPA hoods & TB rooms
High Pressure
• Can alter structure of proteins
• Kill vegetative forms
• Endospores relatively resistant
• Osmotic pressure reduces availability of water
Radiation
• Ionizing radiation-less than 1nm– Gamma rays-cobalt or electron beams– X rays
• Principle-ionization of water
Chemicals
• Considered pesticides• Regulated by EPA• Sterilants-sterilize in 6-10 hrs• High level disinfection do not kill all endospores
• Intermediate level kill bacteria and some viruses• Low level – general purpose
Microbial Characteristics
• Gram negatives more resistant– External layer of lipopolysaccharide– Porins –holes in cell wall, selective
• Mycobacterium-lipids in cell wall
• Viruses without a lipid layer more resistant
History
• Paul Ehrlich- magic bullets• Chemotherapeutic agent
• Antimicrobial• Antibiotic• Synthetic drugs produced in lab
History
• Sulfa drugs- wide spread use in 1935• Fleming-penicillin in 1928
• Waksman- bacteria from soil- Streptomyces griseus-streptomycin
Selective Toxicity
• Harm microbe without causing significant damage to host
• Penicillin
• Streptomycin to tx TB
Drug Administration
• Effective concentration of abx to site of infection-route
• Topical-infection at body surface– Athlete’s feet
• Systemic-IV fastest but need hospitalization• IM intra muscular- peak levels in BS within 15
mins
Drug Administration
• PO- enters GI then into BS– Painless, but slower and not as effective– Only fraction enters BS– Must follow directions– Great for outpts
Drug Distribution
• Barriers to fast distribution: cell membrane & proteins– Prevent entry or bind drug
• CM of cells around BS can prevent free passage into tissues from blood vessels
Drug Distribution
• Drug binding proteins
• Penicillin: about 65% reversible bound to albumin
• Race between distribution of drug and elimination
Elimination of Drugs
• Converted metabolically to another compound: liver
• Excreted
• Penicillin excreted rapidly via kidneys
• Within 90 minutes, most in urine
• Take regularly and often or
• Resistance can develop
Drug Resistance
• Natural or acquired resistance• Species lacks target: penicillin attacks
peptidoglycan in cell wall
• Many can’t enter gram negative cell wall
Spectrum of Activity
• Range of microbes the agent acts against
• Broad –gram positive & negative
• Narrow –small number of microbes
• Prevents destruction of normal flora
Acquired Resistance
• Broad spectrum antibiotic changes normal flora:
• Mutations and genetic exchange among bacteria
• Antibiotics favor resistant strains but do not cause genetic changes
Mechanisms
• Alteration of target of drug action
• Alteration of membrane permeability
• Efflux or pumps out the drug
Genetics
• Mutations on chromosome• Develop gradually over years of antibiotic
usage• Need higher & higher concentrations of
drug• Eventually becomes useless
Plasmid Borne Genes
• Occurs almost immediate via genetic recombination
• R plasmids or factors
• Penicillin resistance from beta- lactamase is an example
Slowing Use of Antibiotics
• 3/4 of all hospital pts receive several courses of abxs-over kill
• 50 million of 150 million outpatient antibiotics are unneeded
• Maintain high levels in body long enough to kill all pathogens
Slow Resistance
• Limit use of antibiotics in animals
• Transmission of drug resistant organisms from animals to humans
• Some countries drugs sold over the counter
Drug Dosage
• Depends upon route of administration, drug distribution, drug elimination
• Effective concentration depends upon susceptibility of organism to drug
• Kirby-Bauer method– MIC: minimum inhibitory concentration– Microbial sensitivities
Kirby Bauer Method
• Disk diffusion method-standardized
• Agent spread over MH plate
• Disks impregnated with antibiotic
• Agent diffuse out, lower MW faster
• Zones of inhibition-clear areas around disk
• Standardized for S, R I
Targets of Antimicrobial Drugs
• Bactericidal-kills
• Bacteriostatic-inhibits growth– Phagocytosis & antibodies kill organisms
• Inhibition of cell wall synthesis
Cell Membrane
• Membrane of bacteria & fungi differ somewhat from animal cell membranes– Some selective toxicity but not ideal
Inhibition of Protein Synthesis
• Selective toxicity depends upon difference between ribosomes
• Bacteria-70S (30S & 50S) & animals -80S– Human 40S & 60S but mitochondria have 70S– Side effects do occur