antibiotics classes mechanisms of action visual educational video animation

A detailed educational diagram showing antibiotic classification and mechanisms of action. A bacterial cell in the center with labeled arrows pointing to different cellular targets: 1) Cell wall synthesis inhibitors (beta-lactams: penicillins, cephalosporins, carbapenems; glycopeptides: vancomycin) attacking the peptidoglycan layer, 2) Protein synthesis inhibitors divided into 30S ribosome (aminoglycosides, tetracyclines) and 50S ribosome (macrolides, clindamycin, chloramphenicol) targets, 3) DNA/RNA synthesis inhibitors (fluoroquinolones targeting DNA gyrase, rifampin targeting RNA polymerase), 4) Cell membrane disruptors (polymyxins), 5) Folate synthesis inhibitors (sulfonamides, trimethoprim). Each class labeled with drug examples and whether bactericidal or bacteriostatic. Color coded by mechanism. Clean, professional medical illustration style.

A professional medical quick reference poster titled "ANTIBIOTIC MECHANISMS OF ACTION" for medical students and clinicians. Dark navy blue background with clean white and colored text. Organized into 6 color-coded sections arranged around a central diagram of a bacterial cell: TOP LEFT (red section): CELL WALL SYNTHESIS INHIBITORS - Beta-lactams (Penicillins, Cephalosporins, Carbapenems, Monobactams) - block PBPs; Glycopeptides (Vancomycin) - block D-Ala-D-Ala; Bacitracin - blocks C55-PP recycling. BACTERICIDAL. TOP RIGHT (blue section): DNA/RNA SYNTHESIS INHIBITORS - Fluoroquinolones (Cipro, Levo) - inhibit DNA gyrase & Topo IV; Rifampin - inhibits RNA polymerase; Metronidazole - DNA strand breaks; Nitrofurantoin - DNA damage. BACTERICIDAL. MIDDLE LEFT (green section): 30S RIBOSOME INHIBITORS - Aminoglycosides (Gentamicin) - misreading of mRNA - CIDAL; Tetracyclines (Doxycycline) - block tRNA binding - STATIC. MIDDLE RIGHT (orange section): 50S RIBOSOME INHIBITORS - Macrolides (Azithromycin) - block translocation - STATIC; Clindamycin - peptide bond formation - STATIC; Linezolid - initiation complex - STATIC; Chloramphenicol - peptidyltransferase - STATIC. BOTTOM LEFT (purple section): CELL MEMBRANE DISRUPTORS - Polymyxins (Colistin) - outer membrane detergent - Gram-neg; Daptomycin - membrane depolarization - Gram-pos. BACTERICIDAL. BOTTOM RIGHT (yellow section): FOLATE PATHWAY INHIBITORS - Sulfonamides - block PABA/dihydropteroate synthase; Trimethoprim - blocks DHFR; TMP-SMX combo = synergistic double blockade. BACTERIOSTATIC. CENTER: Simple bacterial cell cross-section with labeled arrows pointing to each target site. Bottom footer: Bactericidal vs Bacteriostatic legend. Clean, readable, clinical poster design.

A clean, modern medical education title slide background. Deep navy blue to dark teal gradient. Subtle bacterial cell silhouettes and DNA helix patterns in the background as faint watermarks. Professional, clinical, scientific feel. No text. Horizontal 16:9 format.

Educational diagram showing the 4 main mechanisms of antibiotic resistance in bacteria on a dark navy background. Four distinct panels arranged in a 2x2 grid with bright colored icons: 1) Top-left in red - "Enzymatic Inactivation" showing a beta-lactamase enzyme breaking a beta-lactam ring structure; 2) Top-right in orange - "Target Modification" showing a modified PBP2a protein with altered binding site, MRSA mecA gene label; 3) Bottom-left in green - "Efflux Pumps" showing drug molecules being actively pumped out of a bacterial cell membrane; 4) Bottom-right in blue - "Reduced Permeability" showing blocked or downregulated porin channels in outer membrane preventing drug entry. Each panel labeled with mechanism name and small drug examples. Clean medical illustration style, white text on dark panels.

Medical infographic on a dark navy blue background showing beta-lactamase enzymes and drug resistance. Central illustration of a bacterial cell with a large beta-lactam ring structure (penicillin structure) being cleaved/destroyed by a beta-lactamase enzyme (shown as scissors or pac-man). Four types labeled with colored badges: Class A (red) - ESBLs, KPC; Class B (orange) - Metallo-beta-lactamases NDM, VIM, IMP; Class C (yellow) - AmpC cephalosporinases; Class D (green) - OXA carbapenemases. Arrow showing: drug enters → enzyme destroys → drug inactive. Clinical education illustration style, clean white labels.

Medical education infographic showing horizontal gene transfer and spread of antibiotic resistance on dark navy background. Three mechanisms illustrated with clean colorful diagrams: 1) Conjugation - two bacteria connected by a pilus with a plasmid transferring between them, labeled R-plasmid; 2) Transformation - a bacterium picking up naked DNA fragments from environment labeled with resistance genes; 3) Transduction - bacteriophage virus particle injecting resistance gene DNA into a bacterium. Arrows showing direction of gene transfer. Clinical, professional illustration style, light text on dark background, color coded.

Medical education infographic on dark navy background showing ESKAPE pathogens and multidrug resistant organisms. Six organisms listed with colored icons and resistance profiles: Enterococcus faecium (VRE) - vancomycin resistant; Staphylococcus aureus (MRSA) - methicillin resistant, mecA gene; Klebsiella pneumoniae (KPC) - carbapenem resistant; Acinetobacter baumannii (CRAB) - pan-drug resistant; Pseudomonas aeruginosa - intrinsic + adaptive resistance; Enterobacter species (ESBL) - extended spectrum beta-lactamase. Each pathogen with a clinical setting icon (hospital, ICU). Color gradient from yellow to red showing increasing resistance severity. Last resort antibiotics listed: colistin, tigecycline, ceftazidime-avibactam. Clean professional medical illustration.

Medical education poster on dark navy background showing antibiotic stewardship strategies and solutions to combat resistance. Clean infographic with 5 sections connected by arrows: 1) De-escalation - narrow spectrum when culture results known; 2) Appropriate Duration - stop when infection cleared, avoid prolonged courses; 3) Right Drug, Right Dose - PK/PD optimization, therapeutic drug monitoring; 4) Diagnostics - rapid molecular testing, blood cultures before antibiotics; 5) Infection Prevention - hand hygiene, isolation precautions, vaccination. Center icon shows balance scale between treating infection and preserving antibiotics. Professional clinical style, icons, light text.

mkdir -p /home/daytona/workspace/antibiotic-resistance-pptx && ls /home/daytona/…

~/antibiotic-resistance-pptx/build.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch all slide images
const imageUrls = [
  "https://cdn.orris.care/image-gen/4c2486cec09340f388f8db4e35f08060.png", // title bg
  "https://cdn.orris.care/image-gen/818ce80782264281a3c163a1003d08d6.png", // 4 mechanisms
  "https://cdn.orris.care/image-gen/6f05be22f8a34454bf279e71264182a8.png", // beta-lactamase
  "https://cdn.orris.care/image-gen/b3045876d68249beb3215fdc203e7dc4.png", // HGT
  "https://cdn.orris.care/image-gen/b2e93e59469746349dbdf1c7fdc7594f.png", // ESKAPE
  "https://cdn.orris.care/image-gen/3241fdb8975e4183b849c463de4324e7.png", // stewardship
];

console.log("Fetching images...");
const imagesRaw = execSync(
  `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`
).toString();
const images = JSON.parse(imagesRaw);
console.log("Images fetched:", images.map(i => i.error || "OK"));

// Color palette
const NAVY    = "0A1628";
const TEAL    = "0E7490";
const TEAL2   = "06B6D4";
const WHITE   = "FFFFFF";
const YELLOW  = "FACC15";
const RED     = "EF4444";
const ORANGE  = "F97316";
const GREEN   = "22C55E";
const GRAY    = "94A3B8";
const LTGRAY  = "CBD5E1";

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Antibiotic Resistance Mechanisms";
pres.author = "Orris Medical Education";
pres.subject = "Pharmacology / Infectious Disease";

// ─────────────────────────────────────────────
// SLIDE 1 – Title
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  // full-bleed bg image
  sl.addImage({ data: images[0].base64, x: 0, y: 0, w: 10, h: 5.625 });
  // dark overlay
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY, transparency: 30 } });

  // accent bar
  sl.addShape(pres.ShapeType.rect, { x: 0.7, y: 1.5, w: 0.08, h: 1.8, fill: { color: TEAL2 }, line: { color: TEAL2 } });

  sl.addText("ANTIBIOTIC RESISTANCE", {
    x: 0.9, y: 1.45, w: 8.5, h: 0.75,
    fontSize: 36, bold: true, color: WHITE, fontFace: "Calibri",
    charSpacing: 3, margin: 0
  });
  sl.addText("MECHANISMS", {
    x: 0.9, y: 2.1, w: 8.5, h: 0.75,
    fontSize: 36, bold: true, color: TEAL2, fontFace: "Calibri",
    charSpacing: 3, margin: 0
  });
  sl.addText("A comprehensive guide for medical students & clinicians", {
    x: 0.9, y: 3.0, w: 8.5, h: 0.45,
    fontSize: 16, color: LTGRAY, fontFace: "Calibri", italic: true, margin: 0
  });
  sl.addText("Sources: Harrison's Principles of Internal Medicine 22E  |  Goodman & Gilman's Pharmacological Basis of Therapeutics", {
    x: 0.9, y: 4.9, w: 9, h: 0.35,
    fontSize: 9, color: GRAY, fontFace: "Calibri", margin: 0
  });
}

// ─────────────────────────────────────────────
// SLIDE 2 – Agenda / Overview
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: TEAL }, line: { color: TEAL } });

  sl.addText("LECTURE OVERVIEW", {
    x: 0.4, y: 0.12, w: 9, h: 0.65,
    fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  const topics = [
    ["01", "The 4 Core Resistance Mechanisms", "Enzymatic inactivation, target modification, efflux, permeability"],
    ["02", "Beta-Lactamases Deep Dive", "Classes A-D, ESBLs, KPC, NDM – the Ambler classification"],
    ["03", "Horizontal Gene Transfer", "Conjugation, transformation, transduction – how resistance spreads"],
    ["04", "ESKAPE Pathogens", "The 6 most dangerous multidrug-resistant organisms"],
    ["05", "MRSA & Vancomycin Resistance", "mecA gene, PBP2a, van genes – clinical implications"],
    ["06", "Antibiotic Stewardship", "De-escalation, diagnostics, PK/PD optimization"],
  ];

  topics.forEach(([num, title, sub], i) => {
    const row = i % 3;
    const col = Math.floor(i / 3);
    const x = 0.4 + col * 4.9;
    const y = 1.15 + row * 1.38;

    sl.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 1.15, fill: { color: "0D2240" }, line: { color: TEAL, w: 1.5 }, rounding: 0.08 });
    sl.addText(num, { x: x + 0.12, y: y + 0.1, w: 0.5, h: 0.45, fontSize: 20, bold: true, color: TEAL2, fontFace: "Calibri", margin: 0 });
    sl.addText(title, { x: x + 0.62, y: y + 0.08, w: 3.7, h: 0.38, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
    sl.addText(sub, { x: x + 0.62, y: y + 0.5, w: 3.7, h: 0.5, fontSize: 10, color: GRAY, fontFace: "Calibri", margin: 0 });
  });
}

// ─────────────────────────────────────────────
// SLIDE 3 – The 4 Core Mechanisms (image)
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: RED }, line: { color: RED } });
  sl.addText("THE 4 CORE RESISTANCE MECHANISMS", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  sl.addImage({ data: images[1].base64, x: 0.3, y: 1.05, w: 9.4, h: 4.35 });

  sl.addText("Harrison's Principles of Internal Medicine 22E", {
    x: 0.4, y: 5.35, w: 9, h: 0.2, fontSize: 8, color: GRAY, fontFace: "Calibri", italic: true, margin: 0
  });
}

// ─────────────────────────────────────────────
// SLIDE 4 – Mechanism Details (text)
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: RED }, line: { color: RED } });
  sl.addText("4 MECHANISMS — KEY DETAILS", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  const boxes = [
    { color: RED,    title: "1. Enzymatic Inactivation", bullets: ["Beta-lactamases destroy beta-lactam ring", "Aminoglycoside-modifying enzymes", "Chloramphenicol acetyltransferase", "Classes A–D (Ambler classification)"] },
    { color: ORANGE, title: "2. Target Modification",   bullets: ["MRSA: mecA gene → PBP2a (altered PBP)", "Vancomycin resistance: van gene → altered D-Ala-D-Lac", "Fluoroquinolone resistance: gyrA / parC mutations", "Macrolide resistance: 23S rRNA methylation (ermB)"] },
    { color: GREEN,  title: "3. Efflux Pumps",          bullets: ["Actively expel antibiotics from cytoplasm", "mef gene → low-level macrolide resistance", "MexAB-OprM in Pseudomonas aeruginosa", "Contribute to multi-drug resistance (MDR)"] },
    { color: TEAL2,  title: "4. Reduced Permeability",  bullets: ["Loss or downregulation of outer membrane porins", "Intrinsic mechanism in P. aeruginosa", "Combined with efflux → pan-drug resistance", "Limits entry of carbapenems, aminoglycosides"] },
  ];

  boxes.forEach(({ color, title, bullets }, i) => {
    const x = 0.25 + (i % 2) * 4.88;
    const y = 1.02 + Math.floor(i / 2) * 2.22;
    sl.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 2.05, fill: { color: "0D2240" }, line: { color, w: 2 }, rounding: 0.06 });
    sl.addShape(pres.ShapeType.rect, { x, y, w: 4.5, h: 0.42, fill: { color }, line: { color }, rounding: 0.06 });
    sl.addText(title, { x: x + 0.12, y: y + 0.05, w: 4.2, h: 0.33, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
    const bulletItems = bullets.map((b, bi) => ({ text: b, options: { bullet: true, breakLine: bi < bullets.length - 1 } }));
    sl.addText(bulletItems, { x: x + 0.12, y: y + 0.52, w: 4.22, h: 1.45, fontSize: 11, color: LTGRAY, fontFace: "Calibri", lineSpacingMultiple: 1.3 });
  });
}

// ─────────────────────────────────────────────
// SLIDE 5 – Beta-Lactamases (image + text)
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: ORANGE }, line: { color: ORANGE } });
  sl.addText("BETA-LACTAMASES — AMBLER CLASSIFICATION", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  sl.addImage({ data: images[2].base64, x: 0.2, y: 1.0, w: 5.2, h: 4.3 });

  const classes = [
    { cls: "Class A", col: RED,    drugs: "ESBLs (CTX-M), KPC", note: "Carbapenems, ceftaz-avibactam" },
    { cls: "Class B", col: ORANGE, drugs: "NDM, VIM, IMP (metallo-)", note: "Ceftaz-avibactam + aztreonam" },
    { cls: "Class C", col: YELLOW, drugs: "AmpC cephalosporinases", note: "Avoid 3rd gen cephalosporins" },
    { cls: "Class D", col: GREEN,  drugs: "OXA carbapenemases", note: "Ceftaz-avibactam (some)" },
  ];

  classes.forEach(({ cls, col, drugs, note }, i) => {
    const y = 1.05 + i * 1.08;
    sl.addShape(pres.ShapeType.rect, { x: 5.65, y, w: 4.1, h: 0.95, fill: { color: "0D2240" }, line: { color: col, w: 1.5 }, rounding: 0.05 });
    sl.addText(cls, { x: 5.78, y: y + 0.06, w: 1.0, h: 0.3, fontSize: 12, bold: true, color: col, fontFace: "Calibri", margin: 0 });
    sl.addText(drugs, { x: 5.78, y: y + 0.34, w: 3.8, h: 0.25, fontSize: 10.5, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
    sl.addText("Tx: " + note, { x: 5.78, y: y + 0.6, w: 3.8, h: 0.25, fontSize: 9.5, color: GRAY, fontFace: "Calibri", italic: true, margin: 0 });
  });

  sl.addShape(pres.ShapeType.rect, { x: 5.65, y: 5.2, w: 4.1, h: 0.25, fill: { color: "122035" }, line: { color: ORANGE, w: 1 } });
  sl.addText("⚠  ESBL ≠ Carbapenemase — do not use piperacillin-tazobactam for high-inoculum ESBL infections", {
    x: 5.68, y: 5.2, w: 4.05, h: 0.25, fontSize: 8.5, color: YELLOW, fontFace: "Calibri", bold: true, margin: 0
  });
}

// ─────────────────────────────────────────────
// SLIDE 6 – Horizontal Gene Transfer
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: GREEN }, line: { color: GREEN } });
  sl.addText("HORIZONTAL GENE TRANSFER (HGT)", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  sl.addImage({ data: images[3].base64, x: 0.2, y: 0.95, w: 9.6, h: 4.4 });

  // overlay text boxes at bottom
  const methods = [
    { name: "Conjugation", detail: "Direct cell-to-cell pilus contact; transfers R-plasmids; most clinically significant HGT", color: GREEN },
    { name: "Transformation", detail: "Uptake of naked DNA from environment; natural competence in Strep pneumoniae, H. influenzae", color: TEAL2 },
    { name: "Transduction", detail: "Bacteriophage carries resistance genes between bacteria; can cross species barriers", color: YELLOW },
  ];

  methods.forEach(({ name, detail, color }, i) => {
    const x = 0.25 + i * 3.28;
    sl.addShape(pres.ShapeType.rect, { x, y: 4.82, w: 3.1, h: 0.7, fill: { color: NAVY, transparency: 20 }, line: { color, w: 1.5 } });
    sl.addText(name, { x: x + 0.08, y: 4.84, w: 2.9, h: 0.22, fontSize: 11, bold: true, color, fontFace: "Calibri", margin: 0 });
    sl.addText(detail, { x: x + 0.08, y: 5.05, w: 2.9, h: 0.42, fontSize: 8.5, color: LTGRAY, fontFace: "Calibri", margin: 0 });
  });
}

// ─────────────────────────────────────────────
// SLIDE 7 – ESKAPE Pathogens
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: "7C3AED" }, line: { color: "7C3AED" } });
  sl.addText("ESKAPE PATHOGENS", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  sl.addImage({ data: images[4].base64, x: 0.2, y: 0.95, w: 5.5, h: 4.45 });

  const eskape = [
    { letter: "E", org: "Enterococcus faecium", resistance: "VRE — vancomycin resistant", tx: "Linezolid, daptomycin", color: RED },
    { letter: "S", org: "Staphylococcus aureus", resistance: "MRSA — mecA → PBP2a", tx: "Vancomycin, linezolid, daptomycin", color: ORANGE },
    { letter: "K", org: "Klebsiella pneumoniae", resistance: "KPC carbapenemase (Class A)", tx: "Ceftazidime-avibactam, meropenem-vaborbactam", color: YELLOW },
    { letter: "A", org: "Acinetobacter baumannii", resistance: "OXA carbapenemase, efflux, porin loss", tx: "Polymyxin B + sulbactam, cefiderocol", color: GREEN },
    { letter: "P", org: "Pseudomonas aeruginosa", resistance: "Intrinsic + adaptive + acquired resistance", tx: "Ceftolozane-tazobactam, imipenem-relebactam", color: TEAL2 },
    { letter: "E", org: "Enterobacter spp.", resistance: "AmpC + ESBL producers", tx: "Carbapenems, ceftaz-avibactam", color: "818CF8" },
  ];

  eskape.forEach(({ letter, org, resistance, tx, color }, i) => {
    const y = 1.0 + i * 0.76;
    sl.addShape(pres.ShapeType.rect, { x: 5.9, y, w: 3.85, h: 0.68, fill: { color: "0D2240" }, line: { color, w: 1.5 }, rounding: 0.04 });
    sl.addText(letter, { x: 5.95, y: y + 0.1, w: 0.32, h: 0.48, fontSize: 18, bold: true, color, fontFace: "Calibri", align: "center", margin: 0 });
    sl.addShape(pres.ShapeType.line, { x: 6.32, y: y + 0.08, w: 0, h: 0.52, line: { color, w: 1 } });
    sl.addText(org, { x: 6.42, y: y + 0.06, w: 3.25, h: 0.24, fontSize: 11, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });
    sl.addText(resistance, { x: 6.42, y: y + 0.27, w: 3.25, h: 0.2, fontSize: 9.5, color: GRAY, fontFace: "Calibri", margin: 0 });
    sl.addText("Tx: " + tx, { x: 6.42, y: y + 0.47, w: 3.25, h: 0.18, fontSize: 9, color: TEAL2, fontFace: "Calibri", italic: true, margin: 0 });
  });
}

// ─────────────────────────────────────────────
// SLIDE 8 – MRSA & Vancomycin Resistance
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: RED }, line: { color: RED } });
  sl.addText("MRSA & VANCOMYCIN RESISTANCE", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  // MRSA box
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.05, w: 4.3, h: 4.3, fill: { color: "0D2240" }, line: { color: RED, w: 2 }, rounding: 0.06 });
  sl.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.05, w: 4.3, h: 0.48, fill: { color: RED }, line: { color: RED }, rounding: 0.06 });
  sl.addText("MRSA", { x: 0.42, y: 1.1, w: 4.0, h: 0.38, fontSize: 15, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });

  const mrsaPoints = [
    "mecA gene encodes PBP2a (penicillin-binding protein 2a)",
    "PBP2a has low affinity for ALL beta-lactams",
    "Located on SCC mec (Staphylococcal Chromosome Cassette)",
    "HA-MRSA: SCC mec types I-III → high resistance, low virulence",
    "CA-MRSA: SCC mec types IV-V → more virulent, Panton-Valentine Leukocidin",
    "50% of S. aureus isolates are methicillin resistant",
    "Treatment: Vancomycin (target AUC/MIC ≥400), linezolid, daptomycin",
    "Alternatives: Ceftaroline (only cephalosporin active vs MRSA)",
  ];
  sl.addText(mrsaPoints.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < mrsaPoints.length - 1 } })), {
    x: 0.42, y: 1.64, w: 4.05, h: 3.6, fontSize: 10.5, color: LTGRAY, fontFace: "Calibri", lineSpacingMultiple: 1.35
  });

  // VRE box
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.05, w: 4.6, h: 2.05, fill: { color: "0D2240" }, line: { color: ORANGE, w: 2 }, rounding: 0.06 });
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.05, w: 4.6, h: 0.48, fill: { color: ORANGE }, line: { color: ORANGE }, rounding: 0.06 });
  sl.addText("VRE (Vancomycin-Resistant Enterococci)", { x: 5.22, y: 1.1, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });

  const vrePoints = [
    "van gene → altered peptidoglycan precursor (D-Ala-D-Lac instead of D-Ala-D-Ala)",
    "Vancomycin cannot bind → resistance",
    "40% of Enterococcus isolates are vancomycin resistant",
    "More common in E. faecium than E. faecalis",
    "Treatment: Linezolid, daptomycin (high dose), tigecycline",
  ];
  sl.addText(vrePoints.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < vrePoints.length - 1 } })), {
    x: 5.22, y: 1.64, w: 4.35, h: 1.38, fontSize: 10, color: LTGRAY, fontFace: "Calibri", lineSpacingMultiple: 1.3
  });

  // Resistance testing box
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 3.28, w: 4.6, h: 2.08, fill: { color: "0D2240" }, line: { color: TEAL2, w: 2 }, rounding: 0.06 });
  sl.addShape(pres.ShapeType.rect, { x: 5.1, y: 3.28, w: 4.6, h: 0.48, fill: { color: TEAL }, line: { color: TEAL }, rounding: 0.06 });
  sl.addText("Resistance Detection Methods", { x: 5.22, y: 3.33, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 });

  const detectPoints = [
    "MIC testing: gold standard (broth microdilution)",
    "mecA PCR: rapid MRSA detection",
    "Whole genome sequencing: comprehensive resistance profiling",
    "Rapid molecular panels: ID + resistance in <2 hours",
  ];
  sl.addText(detectPoints.map((t, i) => ({ text: t, options: { bullet: true, breakLine: i < detectPoints.length - 1 } })), {
    x: 5.22, y: 3.87, w: 4.35, h: 1.38, fontSize: 10, color: LTGRAY, fontFace: "Calibri", lineSpacingMultiple: 1.3
  });
}

// ─────────────────────────────────────────────
// SLIDE 9 – Antibiotic Stewardship
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY }, line: { color: NAVY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: GREEN }, line: { color: GREEN } });
  sl.addText("ANTIBIOTIC STEWARDSHIP", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 20, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  sl.addImage({ data: images[5].base64, x: 0.2, y: 0.95, w: 9.6, h: 4.45 });

  const stewardship = [
    { title: "De-escalation", detail: "Narrow spectrum based on culture & sensitivity results. Avoid prolonged broad-spectrum therapy.", color: GREEN },
    { title: "Diagnostics First", detail: "Blood/urine cultures BEFORE antibiotics. Rapid PCR panels reduce empirical broad-spectrum use.", color: TEAL2 },
    { title: "PK/PD Optimization", detail: "TDM for vancomycin (AUC-guided), aminoglycosides. Extended infusions for carbapenems.", color: YELLOW },
    { title: "Duration Control", detail: "Short courses proven equivalent for most infections. 5 days for CAP, 7 days for pyelonephritis.", color: ORANGE },
  ];

  stewardship.forEach(({ title, detail, color }, i) => {
    const x = 0.25 + (i % 2) * 4.88;
    const y = 4.42 + Math.floor(i / 2) * 0 ;  // overlay on image at bottom — use single row
    // Actually place as semi-transparent overlays
  });
}

// ─────────────────────────────────────────────
// SLIDE 10 – Summary / Key Takeaways
// ─────────────────────────────────────────────
{
  let sl = pres.addSlide();
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  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.9, fill: { color: TEAL }, line: { color: TEAL } });
  sl.addText("KEY TAKEAWAYS", {
    x: 0.4, y: 0.12, w: 9, h: 0.65, fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 2, margin: 0
  });

  // accent bar
  sl.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.05, w: 0.06, h: 4.25, fill: { color: TEAL2 }, line: { color: TEAL2 } });

  const takeaways = [
    { num: "1", text: "4 core mechanisms: enzymatic inactivation, target modification, efflux pumps, reduced permeability — bacteria often combine multiple mechanisms simultaneously." },
    { num: "2", text: "Beta-lactamases are the most prevalent resistance enzymes. Know the Ambler classes: A (ESBLs, KPC), B (NDM, VIM — metalloenzymes), C (AmpC), D (OXA)." },
    { num: "3", text: "Horizontal gene transfer — especially conjugation via R-plasmids — allows rapid spread of resistance within and between species in hospital settings." },
    { num: "4", text: "ESKAPE pathogens account for the majority of hospital-acquired infections. Each has unique resistance profiles requiring tailored therapy." },
    { num: "5", text: "MRSA (mecA → PBP2a) and VRE (van gene → D-Ala-D-Lac) represent the two most critical Gram-positive resistance problems clinically." },
    { num: "6", text: "Stewardship is the main clinical defense: culture before treating, de-escalate when possible, optimize PK/PD dosing, and limit treatment duration." },
  ];

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    const y = 1.1 + i * 0.73;
    sl.addText(num, { x: 0.6, y, w: 0.35, h: 0.4, fontSize: 15, bold: true, color: TEAL2, fontFace: "Calibri", align: "center", margin: 0 });
    sl.addText(text, { x: 1.05, y, w: 8.6, h: 0.58, fontSize: 11.5, color: LTGRAY, fontFace: "Calibri", lineSpacingMultiple: 1.25 });
  });

  // footer
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  sl.addText("Sources: Harrison's Principles of Internal Medicine 22E  |  Current Surgical Therapy 14E  |  Medical Microbiology 9E  |  Goodman & Gilman's Pharmacological Basis of Therapeutics", {
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  });
}

// ─────────────────────────────────────────────
// Write file
// ─────────────────────────────────────────────
const outPath = "/home/daytona/workspace/antibiotic-resistance-pptx/Antibiotic_Resistance_Mechanisms.pptx";
pres.writeFile({ fileName: outPath }).then(() => {
  console.log("SUCCESS: " + outPath);
}).catch(err => {
  console.error("ERROR:", err);
});

cd /home/daytona/workspace/antibiotic-resistance-pptx && node build.js 2>&1

~/antibiotic-resistance-pptx/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/antibiotic-resistance-pptx/build.js'

cd /home/daytona/workspace/antibiotic-resistance-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/antibiotic-resistance-pptx/Antibiotic_Resistance_…