SUPERBUGS METHICILLIN- VANCOMYCIN- EXTENDED CARBAPENEM- CLOSTRIDIU ACINETOBACTER BURKHOLDERIA ESCHERICHIA

RESISTANT RESISTANT SPECTRUM RESISTANT M DIFFICILE BAUMANNII CEPACIA COLI

STAPHYLOCOC ENTEROCOCC BETA-LACTAMA ENTEROBACTE SEQUENCE
CUS AUREUS US (VRE) SE (ESBL) RIACEAE (CRE) TYPE 132 H30
(MRSA) (E.coli H30-Rx)

STRAIN/ staphylococcus enterococcus Escherichia coli Enterobacteriace Clostridioides Acinetobacter burkholderia H30 strain of
BACTERIA aureus ● Lives in gut ae difficile or C. baumannii cepacia Escherichia coli
seen in ● Found in gi difficile ● Opportunistic ● found in soil sequence type
● gi tract Klebsiella tract ● Causes pathogen and water 131 (ST131-
● Female ● lives in your severe ● One of the ● colonizer of H30)
genital tract mouth, nose, diarrhea most fluids used in ● Found in gi
and gut and collitis challenging the hospital tract
Doesn’t make us bacterial (e.g., irrigation
sick Both are pathogens solutions,
normally intravenous
harmless fluids)

SYMPTOMS ● Red ● Watery

● Swollen diarrhea as
● Painful often as 10
● Warm to the to 15 times
touch a day
● Full of pus or Abdominal
other cramping
drainage and pain,
● Accompanied which may
by a fever be severe
Rapid heart
rate
● Dehydr
ation
● Fever
● Nausea
● Increas
ed
white
blood
cell
count
Kidney
failure
 ● Loss of
appetit
e
● Swollen
abdom
en
● Weight
loss
● Blood
or pus
in the
stool

TREATMENT ● Vancomycin ● Penicillin or ● Cefepime, ● Polymyxins, ● Vancomyc ● Carbapenems ● Trimethoprim- ● Fluoroquin

or amoxicillin piperacillin-t tigecycline, in (125 mg (imipenem, sulfamethoxaz olones,
daptomycin ● +/- azobactam, fosfomycin, given four meropenem,dor ole such as
● Trimethoprim aminoglycosi eravacycline, and times daily ipenem) (TMP-SMX) ciprofloxa
-sulfamethox de, QPD, or plazomicin, aminoglycos for 10 and cin, and
azole (brand newer agents omadacycline ides as the days) or ceftazidime levofloxaci
name: such as LZD, , mainstays of fidaxomici n, are
bactrim), daptomycin, ceftolozane-t therapy n (200 mg usually the
clindamycin, and azobactam, given twice first-line
minocycline, tigecylcine ceftazidime-a Combination daily for 10 therapy
linezolid, or vibactam, therapeutic days) ● Azithromy
doxycycline fosfomycin, strategies ● Limit the cin
nitrofurantoin, ● High- dose use of
fluoroquinolo tigecycline metronidaz
nes, and ● High-dose ole to
tigecycline prolonged-inf cases in
usion of which
carbapenem vancomyci
Double- n or
carbapenem fidaxomicin
therapy are
unavailable
New antibiotics or
● Ceftazidime/ contraindic
avibactam ated
Meropenem/
vaborbactam
Plazomicin
● Eravacycline
 New antibiotics
in development
● Imipenem/
cilastatin and
relebactam
Cefiderocol

MultiDrug Resistant Organisms

● MRSA, VRE, ESBL, CRE, and Klebsiella pneumoniae carbapenemase (KPC)
● most common
○ Acinetobacter baumannii
○ E.coli
○ Mrsa
○ Klebsiella pneumoniae (esbl)

Multidrug-Resistant Pseudomonas Aeruginosa

● Tx: Ceftazidime-avibactam (Avycaz), ceftolozane-tazobactam (Zerbaxa), cefiderocol, and imipenem-cilastatin/ relebactam
● resistant to all agents (ceftazidime, cefepime, aztreonam, ciprofloxacin, piperacillin, and gentamicin)

Multidrug-Resistant TB
● resistant to at least isoniazid and rifampin
● Tx: Levofloxacin 750 mg/day and moxifloxacin 450 mg/day

Healthcare-Acquired Infections (HAls)

● sometimes called Healthcare-Associated Infections
● Formerly known as nosocomial/ hospital acquired infections

Endemic disease - constantly present in a certain population or region,

Epidemic disease - when there is a sudden increase in cases spreading through a large population like a country

Pandemic disease - when there is a sudden increase in cases spreading through several countries, continents or the whole world
CLASSIFICATION CLASS A
● highest risk
● can be easily disseminated or
transmitted from person to person
● high mortality rates
PATHOGENS ● Bacillus anthracis (anthrax)
● Clostridium botulinum toxin (botulism)
● Yersinia pestis (plague)
● Variola major (smallpox) and other
related pox viruses (monkeypox)
● Francisella tularensis (tularemia)
● Viral hemorrhagic fevers
○ Arenaviruses - Junin, Machupo,
Guanarito, Chapare (new in fiscal
year (FY14), Lassa, Lujo (new in
FY14)
○ Bunyaviruses - Hantaviruses
causing Hanta Pulmonary
syndrome, Rift Valley Fever,
Crimean Congo Hemorrhagic
Fever
● Flaviviruses - Dengue
● Filoviruses - Ebola and Marburg
viruses
CLASS B
● Second highest priority
organisms/biological agents
● Moderately easy to disseminate
● Result in moderate morbidity rates
and low mortality rates
● Burkholderia pseudomallei -
melioidosis Coxiella burnetii - Q fever
● Brucella species - brucellosis
Burkholderia mallei - glanders
Chlamydia psittaci - psittacosis
● Ricin toxin - ricinus communis
● Epsilon toxin - clostridium perfringens
● Staphylococcus enterotoxin B (SEB)
● Typhus fever - Rickettsia prowazekii
● Food- and water-borne pathogens
○ Bacteria Diarrheagenic e. coli
Pathogenic vibrios Shigella
species Salmonella
● Viruses - caliciviruses, hepatitis
● Protozoa
○ Cryptosporidium parvum
Entamoeba histolytica
Toxoplasma gondii
● Fungi - microsporidia
● Mosquito-borne viruses West Nile
virus (WNV)
○ LaCrosse encephalitis (LACV)
○ California encephalitis
○ Venezuelan equine encephalitis
(VEE) Eastern equine
encephalitis (EEE)
○ Western equine encephalitis
(WEE)
○ Japanese encephalitis virus (JE)
○ St. Louis encephaltiis virus
(SLEV)
○ Yellow fever virus (YFV)
○ Chikungunya virus
CLASS C
● could be engineered for mass
dissemination in the future because
of:
○ Availability
○ Ease of production and
dissemination
● Potential for high morbidity and
mortality
● Nipah and Hendra viruses
● Additional hantaviruses
● Tickborne hemorrhagic fever viruses
● Tickborne encephalitis complex
flaviviruses
● Tuberculosis, including drug-resistant
TB
● Influenza virus
● Other rickettsias
● Rabies virus
● Prions
● Coccidioides spp.
● Severe acute respiratory syndrome
associated coronavirus (SARS-CoV),
MERS-CoV, and other highly
pathogenic human coronaviruses
● Antimicrobial resistance
 ○ Zika virus

CLASS A

DISEASE EBOLA VIRUS MONKEYPOX

Family/Genus Filoviridae/Ebola Virus Poxviridae/Orthopoxvirus

Reservoir / Host animal-borne; bats mostly likely the reservoir unknown ; most likely rodents

Mode of Transmission Direct contact zoonotic; animal to human , direct contact, droplet

Incubation 2 to 21 days (average 8-10 days) 5 to 21 days (average 6 to 13 days)

Diagnosis ● Automated or semi-automated nucleic acid tests ● PCR for skin

(NAT) ● PCR blood test
● Rapid antigen ● Biopsy

Treatments/Medication/Vaccine ● Immazeb and Ebanga ● Tecovirimat

● Ervebo vaccine (18 years old and above) ● Jynneos (Imvamune or Imvanex)
● Zabdeno-and-Mvabea (1 year and older) ● Acam2000 Vaxx

CLASS B

DISEASE ZIKA VIRUS - mosquito-borne virus

Family/Genus flavivirus

Reservoir / Host vector-borne; Ae. aegypti and Ae. albopictus mosquito

Mode of Transmission sexual, blood and maternal transmission

Incubation 3-14 days

Diagnosis ● Reverse transcription-polymerase chain reaction (RT- PCR)

● Travel history

Treatments/Medication/Vaccine ● No vaccine available yet

● Safe sexual practices or sexual abstinence
● Protection against mosquito bites
 CLASS C

DISEASE COVID-19

Family/Genus sars cov

Reservoir / Host

Mode of Transmission close contact, small droplets, fomites, airborne

Incubation 7-14 days (1-12.5 days)

Diagnosis ● RT-PCR
● Rapid antigen

Treatments/Medication/Vaccine ● Nirmatrelvir with Ritonavir (Paxlovid)

● Remdesivir (Veklury) - antiviral
● Molnupiravir (Lagevrio) - antiviral
● Vaxx
○ mRNA vaxx
■ Pfizer-BioNTech
■ Moderna
○ vector vaxx
■ Janssen or Johnson & Johnson
■ astrazeneca
○ Protein subunit
■ Novovax