Nosocomial Bacterial Infections in Intensive Care Units.

I : Organisms and Mechanisms of antibiotic resistance.

Oleh : Putri Annisa Kamila Pembimbing : Dr. Wiwi Jaya , SpAn.

What is Nosocomial Infection ???

infections that are a result of treatment in a hospital or a healthcare service unit. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge

Nosococomial Infection and ICU...

Between 5% and 15% of hospital in-patients develop an infection during their admission . Critically ill patients in an intensive care unit (ICU) are 510 times more likely to acquire a nosocomial infection than those in general wards

Critically ill patients present special microbiological features .......

Mechanism of Resistance

GRAM POSITIVE BACTERIA Staphylococcus Aureus Coagulase-Negative-S.Aureus

GRAM NEGATIVE BACTERIA Klebsiella spp enterobacter

The microorganisms... Vancomycin Resistant Enterococci Pseudomonas

Acinetobacter Stenothropomonas maltophilia

Gram-positive organisms...

Staphylococcus aureus :

Colonisation and infection...

Antimicrobial Therapy

Coagulase-negative staphylococci
coagulase-negative staphylococci are distinguished from S. aureus by their inability to clot blood plasma . It is a normal commensal at a wide variety of anatomical sites including mucous membranes, groin, axillae and exposed skin surfaces

Infections... They are causative organisms in 19% of nosocomial ICU infections and are by far the most common pathogen isolated in catheter-related bacteraemia Drig of Choice : Vancomycin

Vancomycin-resistant Enterococci

Colonisation and infection ...

There is an association between colonisation with vancomycinresistant Enterococci and the oral or parenteral use of vancomycin, cephalosporins and anti-anaerobic drugs (metronidazole, clindamycin and imipenem)

Vancomycin , etc..

Multiplication

Antimicrobial therapy ... Ampicillin Quinupristin dalfopristin Linezolid Chloramphenicol Nitrofurantoin

Gram-negative organisms Gram-negative bacilli are frequently associated with nosocomial infections in ICU patients, particularly ventilator-associated pneumonia and catheter-associated urinary tract infections

Klebsiella spp.

Klebsiella species belong to the family Enterobacteriaceae that includes Enterobacter spp., Escherichia coli, Proteus spp. and Serratia spp. nosocomial and are typically opportunistic Klebsiella spp. display a particular proclivity for acquiring plasmids. possess extended-spectrum betalactamases.

Colonisation and Infection

urinary tract infections, peritonitis, cholangitis and intra-abdominal infections.

Drug of choice

Enterobacter.

commonest causes of ventilator-associated pneumonia

Resistance and antimicrobial

plasmid

antipseudomonal penicillin betalactamase inhibitor combination and an aminoglycoside

RESISTANT

VERY HARD TO DISSEMINATE !!!!!

 Known resistance mechanisms include plasmid-mediated beta-lactamases, which are also frequently associated with resistance to fluoroquinolones and aminoglycosides .
imipenem remains the most active agent and

is the drug of choice when faced with multiresistant strains.

Stenotrophomonas maltophilia
nosocomial pneumonia, bacteraemia, endocarditis and skin and soft tissue infection

high intrinsic resistance to beta-lactams

Related to prior antibiotics exposure

Co-trimoxazole remains active against most strains and is the agent of choice

Conclusion..
A significant proportion of patients find their hospital stay complicated by an infection. Patients in intensive care units are even more susceptible to nosocomial infections The pathogens isolated in this environment are not usually encountered elsewhere. In addition, they are frequently resistant to many commonly used antibiotics, partly as a result of antibiotic selective pressure . The combined effect of intrinsic and acquired resistance in ICU-acquired infections severely limits antibiotic choice, forcing the development and use of newer antibiotics Nosocomial infections have an impact on morbidity and probably on mortality, and pose a significant economic burden