Multi-drug Resistant Organisms

Aquitania

Multi-drug Resistant Organisms

Bacteria and other microorganisms that developed resistance to antimicrobial drugs

Superbugs

Multi-drug Resistant Organisms

MRSA - methicillin/oxacillin-resistant Staphylococcus aureus VRE - vancomycin-resistant enterococci ESBLs - extended-spectrum beta-lactamaseproducing Enterobacteria (R: to cephalosporins and monobactams) PRSP - penicillin-resistant Streptococcus pneumoniae

Multi-drug Resistant Organisms

Risk factors
Severity of illness Previous exposure to antimicrobial agents Underlying diseases
x x x x Chronic renal disease Insulin-dependent DM Peripheral vascular disease Dermatitis/Skin lesions

Multi-drug Resistant Organisms

Risk factors [cont.]
Invasive procedure
x Dialysis x Presence of invasive devices x Urinary catheterization

Repeated contact with the healthcare system Previous colonization of a multidrug-resistant org. Advanced age

Methicillin resistant Staphylococcus aureus

Skin infection Acquired:
CA-MRSA (Community) HA-MRSA (Hospital)
x Often (R): tetracycline, erythromycin, clindamycin

EMRSA (Epidemic)

Noted first 1961 Resistance: mecA gene

Methicillin resistant Staphylococcus aureus

Flesh-eating bacteria Red rash with lesions (pimple/small boil) Direct contact infected skin, mucus or droplets Indirect objects in contact with infected person

Methicillin resistant Staphylococcus aureus

S&S
CELLULITIS BOILS ABSCESSES STY CARBUNCLES IMPETIGO RASH

Methicillin resistant Staphylococcus aureus

S&S
Occasionally spread to almost any other organ in the body x FEVER, CHILLS, LOW BP, JOINT PAINS, HEADACHES, SHORT NESS of BREATH, RASHES Severe cases x ENDOCARDITIS x NECROTIZING FASCITIS x OSTEOMYELITIS x SEPSIS x DEATH

Methicillin resistant Staphylococcus aureus

Sreening
skin sample, sample of pus from a wound, or blood, urine, or biopsy material rapid blood test (StaphSR Assay)

Prevention
Avoid any kind of contact Good hand hygiene

Combination
vancomycin and linezolid trimethoprimsulfamethoxazole, doxycycline, and clindamycin x Clindamycin may develop resistance Dont stop in the middle of medication

TX:
"First-line treatment for mild abscesses is incision and drainage. (CDC) "If antibiotic treatment is clinically indicated, it should be guided by the susceptibility profile of the organism." (CDC)

Vancomycin-resistant Enterococci
Enterococcus faecium Enterococcus faecalis with E. faecium Resistance: Plasmid (acquired DNA piece)
Able to transfer vancomycin resistance to unrelated bacteria such as MRSA

Vancomycin-resistant Enterococci
Person-to-person contact
Hospital or chronic care facility

Complications:
MENINGITIS PNEUMONIA ENDOCARDITIS

May exist without causing infection Invade bloodstream, or spread locally = abdominal abscess or UTI Open wound

COMPROMISED CONDITION
CANCER DIABETES KIDNEY FAILURE

Vancomycin-resistant Enterococci
S&S (SEPSIS)
FEVER FAST HEART RATE FEEL SICKLY UTI: Burning with urination , Back pain, Fever

TX [Combination]
Teicoplanin and amoxicillin Ampicillin, Polycillin, Imipenem, and vancomycin Can be cured in most patients

DX: Culture (infected tissue)

WOUND INFECTION BLOOD URINE SPUTUM

CONTROL
Transmission Practice of good hand hygiene

Extended-spectrum beta-lactamaseproducing Enterobacteria

K. pneumoniae & E. coli Plasmid-mediated beta-lactamases Capable of efficiently hydrolyzing:
penicillins narrow spectrum cephalosporins many extended-spectrum cephalosporins oxyimino group containing cephalosporins (cefotaxime, ceftazidime) monobactams (aztreonam)

Beta-lactamase inhibitors (clavulanic acid, sulbactam, and tazobactam) generally inhibit ESBL producing strains.

Extended-spectrum beta-lactamaseproducing Enterobacteria

Classification Bush Class A Predominant to ESBLs Hydrolyze: penicillins narrow spectrum cephalosporins many extended-spectrum cephalosporins oxyimino group containing cephalosporins (cefotaxime, ceftazidime) monobactams (aztreonam) Hydrolyze cephamycin or carbapenems (imipenem, meropenem) Primarily chromosomal R: Plasmid-encoded AmpC

Bush Class B

Bush Class C enzymes

Extended-spectrum beta-lactamaseproducing Enterobacteria

DX: Screening test
Ceftazidime resistance marker for ESBL production (Moland et al) Cefpodoxime resistance Initial screening (NCCLS): Cefpodoxime, ceftazidime, aztreonam, cefotaxime, or ceftriaxone x MIC > 1 x Confirmatory: Ceftazidime + ceftazidime/clavulanic acid and cefotaxime +cefotaxime/clavulanic acid

TRANSMISSION
Hospital acquired (Nosomial)

CONTROL
Transmission Practice of good hand hygiene

Penicillin-resistant Streptococcus pneumoniae

Pneumococcus Nasopharynx and throats with causing harm Group A Streptococcus Common in young children, elderly & with severe illness and conditions: chronic lung, heart, or kidney diseas Alcoholic, Diabetes, Immunocompromised, W/o spleen May cause pneumonia, meningitis & bloodstream infection pneumococcal vaccine

Mycobacterium tuberculosis updates

Aquitania

Mycobacterium tuberculosis
Tuberculosis TB
Infectious airborne disease Major global health problem
x x x x x Each year: 9M new cases; 2M deaths All countries are affected but 85% cases occur in: Africa 30% Asia 55% India & China 35%

MDG Goal 6 : Combat HIV/AIDS, malaria & other diseases

World TB Day 2012

March 24th To build public awareness
TB remains an epidemic causing the deaths of several million people each year

1882: Dr Robert Koch discovered the cause of tuberculosis (Berlin)

Mycobacterium tuberculosis
Global Plan to Stop TB 2006 2015 Developing new TB vaccines (Health Protection Agency)
Increase immunity from BCG Modification of BCG by adding immunogenic components Oral delivery of existing BCG strains Construction of safe and stable attenuation of M. tuberculosis