Oswaldo Cruz Institute FIOCRUZ Antimicrobial resistance: where to - - PowerPoint PPT Presentation

Antimicrobial resistance: where to go?

Milton Ozório Moraes

milton.moraes@fiocruz.br

Leprosy laboratory Oswaldo Cruz Institute FIOCRUZ

RIIP meeting 2019 São Paulo

Leprosy Laboratory : A National Reference Center and a Unit of translational medicine

Patient at the resistance confirmation in 2015 and after 3 months of treatment (2017)

2015 2017

Patient – man 61 y/o, from Rio de Janeiro, confirmed in 2015 resistance Clinically presented nodules and infliltrated plaques in whole body; swallown hand, com paresthesis from de membros superiores e inferiores consistente com forma LL. 1971

Monotherapy- Diagnostics and irregular treatment for 2 mo - dapsona (dds)

1975-77

Irregular treatment of RIF and dds for 3 mo

1978 1985-90 1998

complete Treatment RIF and dds (negative BI) 3 MDT doses BI 3+

2002

8 MDT doses IB de 4.7

2013-14

MDT completa IBi 3+ IBf 4.5+

2015

2nd MDT completo IBf 2.5+ e confirmação de resistência Tratamento irregular dds monoterapia até 1977

2016

Diagnosis of esophagous Cancer and cessation of anti-leprosy treatment until completion chemotherapy

2017

Initiation of alternative MDT BI PCR Histopathology PGL-I Probable resistance emergency

Resistance and relapse timeline in a case from leprosy : irregular treatment and neglected care

Antim imicrobial l Resis istance: Launch of world ld and Brazili lian Action pla lans

Antimicrobial Resistance: The Brazilian National Plan -BNP

(i) the promotion of knowledge through communication, education and training campaigns (ii) the development of information systems to monitor resistance in different microorganisms, as well as the volume of antimicrobials used in humans and in agriculture (both in terrestrial and aquatic animals); (iii) strengthening regulation and monitoring of antimicrobial use; (iv) Improve and broaden the knowledge fostering research projects on antimicrobial resistance mechanisms; (vi) To encourage research and innovative approaches using alternatives to antimicrobial agents, as well as new technologies for rapid diagnostics and vaccines in human and animal health; (vii) control and prevent the spread of antimicrobial resistance; (viii) articulate cooperation and funding opportunities within and outside the country for the implementation of the BNP;

The fight against small pox, bubonic plague, and yellow fever epidemics

Fio iocru ruz ari rised as s a resp sponse to a publi lic healt lth emergency

• problem driven
• vertical innovation chain
• wide scope of synergistic activities

Revolta da Vacina - 1904

Work force and productivity (nowadays)

• 12.000 professionals (MD, PhDs, nurses, technicians, pharmacists

social workers; historians; psychologists); 1.200 dedicated PhDs for Science and development

• Two hospitals;
• Three production plants (vaccines/immunobiologicals and

pharmaceuticals, Molecular Biology reagentes for DNA-based tests);

• Reference centers for infectious diseases surveillance;
• 2.500 papers in indexed Journals/year;

The FIOCRUZ-AMR initiative:

• 1. Biocides: research and quality evaluation
• 2. Resistance in Aquatic Environments
• 3. Residues of Veterinary Drugs in food and environmental samples
• 4. Molecular study of antimicrobial resistance mechanisms in different bacterial species involved in hospital infection.
• 5. Study of the genetic diversity of bacteria involved in hospital infection based on the analyzes performed by PFGE, MLST methods.
• 6. Study of mobilization of resistance genes through research and characterization of mobile genetic elements,
• 7. Reference and collections
• 8. Adjuvants (BIO)
• 9. Diagnostic Kits
• 10. Vaccines
• 11. Clinical trials (INI gonorrhea, infant sepsis IFF)
• 12. Prospecting (FAR and IOC biological collections)

Education, communication and information Basic/applied research: BIO, FAR, ICC, IFF, INCQS, INI, IOC, Public health Surveillance: INCQS, INI, IOC Clinical research: IFF, INI, IOC Development and innovation: CDTS, BIO, ICC FAR

736

Proposals submitted

35

Millions in funding

254

Approved

30

Research areas

34%

Approval

492

Reviewers

Innovation Program at Fiocruz – calls

AMR portfolio in the Innovation program

• Analysis of the CRISPR / cas system: Impact on the evolution of resistance
• f pathogenic bacteria
• Applicability of high resolution analysis of DNA dissociation curves in the

prediction of resistance to isoniazid in clinical isolates of Mycobacterium tuberculosis

• Genomic characterization of antimicrobial multiresistance and tolerance to

disinfectants in Corynebacterium striatum isolated from healthcare-related infections

• Investigation of resistance mechanisms in Klebsiella pneumonia using

multi-omics methodology

• Analysis of the main determinants of biofilm formation through the

computational modeling of the multidrug-resistant Pseudomonas aeruginosa producing SPM-1 (ST277)

Axis 2 - Prospecting the biological collections of fungi and Bacillus: bioassay platform (INI) and HCS FAR Axis 4- development of new diagnostic kits for resistance/susceptibility detection (ICC and IOC), strain type, differentiate viral from bacterial infection – novel tools for (meta) genomics Axis 3 – Vaccines, adjuvants and alternative methods Cross-cutting axis- Monitoring, information integration and mathematical modeling of big data (IGM and ICICT) Cross cuting axis - education (UNASUS courses), communication (ICICT, CCS and IOC)

Evaluation FIO-AMR initiatives and networks induced under demand

Axis 1 - Hospital monitoring and surveillance (IAM, ENSP and IOC); solid wastes and water (INCQS).