1. UW MEDICINE │ PATIENTS ARE FIRST BATTLING BUGS: INROADS IN INFECTIOUS DISEASES UW MINI-MEDICAL SCHOOL JOHN LYNCH, MD, MPH FEBRUARY 11, 2014

2. Antibiotics are misused Antibiotic misuse adversely impacts both patients and society Improving antibiotic use improves patient outcomes and saves money Improving antibiotic use is a public health imperative CDC, 2008 SO, WHAT IS THE PROBLEM? 2

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5. CASE 1: DAVID Pseudomonas aeruginosa Escherichia coli

6. CASE 1: DAVID

7. CASE 2: PETER 27-year-old man comes to your clinic with symptoms c/w urethritis. He is sexually active with men (oral and anal sex), HIV-negative 2 months ago. Urine NAAT for GC/CT pending.

8. - #2 most common reported infectious disease in U.S. - ~600,000 cases per year - PID, organ damage, infertility - can be asymptomatic Neisseria gonorrhea

9. 9 Modified from Workowski K A et al. Ann Intern Med 2008;148:606-613 193019401950196019701980199020002010

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13. 13 Goossens, Lancet, 2005

14. 14 Antibiotic use in India (2005-2009) Source: The Evolving Threat of Antimicrobial Resistance, WHO (2012)

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17. 17 “Pitted against microbial genes, we have mainly our wits.” - Joshua Lederberg PhD, 1958