multi-drug resistant organisms plus tb updates

8/6/2019 Multi-Drug Resistant Organisms Plus TB Updates

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Multi-drug Resistant Organisms Aquitania



Multi-drug Resistant Organisms

� MRSA - methicillin/oxacillin-resistant

Staphylococcus aureus� V RE - vancomycin-resistant enterococci

� ESBLs - extended-spectrum beta-lactamase-producing Enterobacteria

(R: to cephalosporins and monobactams)� PRSP - penicillin-resistant Streptococcus pneumoniae




� R isk factors

S

everity of illness Previous exposure to antimicrobial agents

Underlying diseases

x Chronic renal disease

x

Insulin-dependent DMx Peripheral vascular disease

x Dermatitis/Skin lesions




� R isk factors [cont.]

Invasive procedurex Dialysis

x Presence of invasive devices

x Urinary catheterization

R

epeated contact with the healthcare system Previous colonization of a multidrug-resistant org.

Advanced age



Methicillin resistant Staphylococcusaureus� Skin infection

� Acquired: C A -MR S A (Community)

HA -MR S A (Hospital)

x Often (R ): tetracycline, erythromycin, clindamycin

EMR S A (Epidemic)� Noted first ± 1961

� R esistance: mecA gene



Methicillin resistant Staphylococcusaureus

� ³Flesh-eating bacteria´

� R ed rash with lesions(pimple/small boil)

� Direct contact ± infected skin,mucus or droplets

� Indirect ± objects in contact with infected person




� S&S

CELLULITIS

BOILS A BSCESSES

STY

C A R BUNCLES

IMPETIGO

R A SH




� S&S

Occasionally spread to almost

any other organ in the body x FEVER , CHILLS, LOW BP,

JOINT PAINS,HEADA CHES, SHOR TNESS of BR EATH, R A SHES

Severe cases

x ENDOC A R DITIS

x NECR OTIZING F A SCITIS

x OSTEOMYELITIS

x SEPSIS

xDEATH




� Prevention Avoid any kind of contact

Good hand hygiene

� Combination vancomycin and linezolid

trimethoprim-sulfamethoxazole,

doxycycline, and clindamycinx Clindamycin may develop

resistance

Don¶t stop in the middle of medication

� Sreening skin sample, sample of pus

from a wound, or blood,urine, or biopsy material

rapid blood test (StaphSR Assay)

� TX:

"First-line treatment for mildabscesses is incision anddrainage.³ (CDC)

"If antibiotic treatment isclinically indicated, it should be guided by thesusceptibility profile of theorganism." (CDC)



Vancomycin-resistant Enterococci

� Enterococcus faecium

� Enterococcus faecalis with

E.faecium

� R esistance: Plasmid (acquired DN A piece)

Able to transfer vancomycin resistance to

unrelated bacteria such as MR S A




� Person-to-person contact

Hospital or chronic care

facility

� May exist without causinginfection

� Invade bloodstream, or spreadlocally = abdominal abscess orUTI

� Open wound

� Complications:

MENINGITIS

PNEUMONIA ENDOC A R DITIS

� COMPR OMISED CONDITION

C A NCER

DIA B

ETES

KIDNEY F AILUR E




� S&S (SEPSIS)

FEVER

F A ST HEA R T R ATE FEEL SICKLY

UTI: Burning with urination ,Back pain, Fever

� DX: Culture (infected tissue) WOUND INFECTION

BLOOD

UR INE

SPUTUM

� TX [Combination]

Teicoplanin and amoxicillin

Ampicillin, Polycillin,Imipenem, and vancomycin

Can be cured in most patients

� CONTR OL Transmission

Practice of good hand hygiene



Extended-spectrum beta-lactamase-producing 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 ESBLproducing strains.



Extended-spectrum beta-lactamase-producing EnterobacteriaClassification

Bush Class A Predominant to ESBLs

Hydrolyze: penicillinsnarrow spectrum cephalosporinsmany extended-spectrumcephalosporinsoxyimino group containingcephalosporins (cefotaxime,

ceftazidime)monobactams (aztreonam)

Bush Class B Hydrolyze cephamycin orcarbapenems (imipenem,meropenem)

Bush Class C enzymes Primarily chromosomal

R: Plasmid-encoded AmpC



Extended-spectrum beta-lactamase-producing 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 acidand cefotaxime+cefotaxime/clavulanic acid

� TR A NSMISSION

Hospital acquired (Nosomial)

� CONTR OL

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/ospleen

� May cause pneumonia, meningitis & bloodstreaminfection

� ³pneumococcal vaccine´



M

ycobacterium tuberculosisupdates Aquitania



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 R obert 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

multi-drug resistant organisms plus tb updates

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