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Multidrug Resistant Bacteria
Presentation on theme: "Multidrug Resistant Bacteria"— Presentation transcript:
Exception: cefepimeMIC “creep” over timeInducible in the presence of 3rd gen cephSlide10
ESBL E coliSlide11
Plasmid-mediated Resistance in ESBLs
Typically confers resistance to
Multiple classes of ABXs
, always “on”
Found in all
E coli or Klebsiella)
Decr susceptibility to cephalosporins and aztreonam usu suscept
, but avoid
Likely ok to use
cefepime if MIC ≤ 2Best Rx option: carbapenems or pip/tazoSlide13Slide14
ESBL Rx options
limited clinical data, not for UTI, concern for
β-lactam/β-Lactamase Inhibitor Combinations
Variable inhibitory activity
sulbactam & clavulanatePip/tazo—ok for UTI (high urinary concentrations)Cephalosporins—not recommended (?
—uncomplicated UTI onlySlide15
ESBL Rx options (cont
AG, FQ, Bactrim:
Avoid—high risk of developing resistance
No CLSI breakpoints, consider E-test
Inhibits bacterial cell wall synthesis
cidal vs GP and GN Uncomplicated UTISlide16
GNR, GI tract
CA- and HCA-infections
70 genera, but mostly
spUncommon in US before 2000Complex, multiple resistant mechanismsCarbapenemases (KPC, NDM—India/Pakistan)Mortality rates 40-50%Slide18
Risk factors for CRE
Exposure to health care and antimicrobials
Recent organ or stem-cell transplants
Resistant to most β-lactams
Most prevalent and widely distributed
Difficult to detect in the lab
was “canary in the coal mine”New carbapenem MIC breakpointsSlide20
Definition of CRE
using the revised 2010 CLSI breakpoints.Elevated MICs to carbapenems
Similar to ESBL-producing organismsAlso resistant to AG and FQSlide21
Resistant to all 3
DoripenemErtapenem not includedNew breakpointsNo modified Hodge test necessarySlide23
CRE Rx Options
Limited clinical experience
Avoid in UTI and primary BSI
Looks great in vitroSlide25
Infection Control and CRE
Use of dedicated staff?
Miami: 1:1 nursing/RT care
-rectal swabs and wound cxUrinary cathetersCDC workbookSlide26
Cipro +TMP/SMX at MMCSlide27
3918 hospitals (CAUTI or CLABSI surveillance)
181 (4.6%) with ≥ 1 CRE
145 (3.9%) short-term
, 36 (17.8%) LTACH
Highest in large, Northeast teaching hospitalsSlide29
MICHELLE CASTILLO / CBS NEWS/
September 16, 2013, 2:41 PM
CDC: Hospitals major source of antibiotic-resistant infectionsSlide30
More than two million people in the U.S. get drug-resistant infections annually. About 23,000 die from these diseases that are becoming increasingly resistant to antibiotics in doctors' arsenals
CDC director Dr. Tom
during a press conference. "If we're not careful, the medicine chest will be empty when we go there to look for a lifesaving antibiotic for someone with a deadly infection. If we act now, we can preserve these medications while we continue to work on lifesaving medications."Slide31
World Health Organization (WHO) Director-General Dr. Margaret Chan said in March 2012 that the overuse of antibiotics was becoming so common that she feared we may come to a day where
any normal infection could become deadly because bacteria have evolved to survive our treatments.Slide32
antibiotic resistance costs $20 billion in excess health care costs in the U.S. each year, with costs to society for lost productivity reaching as much as an additional $35 billion.
CDC estimated in April that enough antibiotics are prescribed each year for
four out of five Americans to be taking them. Doctors and other health care providers prescribed 258 million courses of antibiotics in 2010 for a population a little less than 309 million. They also estimated in this current report that up to 50 percent of antibiotics are prescribed incorrectly or to people who do not need them.Slide33
CRE infections are caused by a family of 70 bacteria that normally live in the digestive system. They are extremely resistant to even the strongest kinds of antibiotics, and
can kill one out of every two patients who develop bloodstream infections caused by them. Thirty-eight states reported at least one case of CRE last year, up from just one state a decade ago.Slide34
Antimicrobial stewardship programs, which measure and promote the correct use of antibiotics, have been shown to lower antibiotic-resistant infections in different facilities by as much as 80 percent.Slide35
CDC sets threat levels for drug-resistant 'superbugs'
updated 5:48 PM EDT, Tue September 17,
Briefing speakers, report: antibiotic resistant infections “pose a catastrophic threat to people in every country”
RABITA AZIZ ON
SEPTEMBER 18, 2013.
But fighting antimicrobial resistance isn’t possible without committed resources, IDSA President Dr. David Relman said. The CDC’s current budget is the lowest it’s been in a decade, risking a future that may resemble the days before “miracle” drugs were developed, when people died of common infections, Dr.
On superbugs, the CDC sounds an
alarm. (Washington Post Editorial Board) Slide36
CDC director: A disease outbreak anywhere is a risk everywhere
, Special to CNN
updated 7:23 AM EDT, Fri September 20, 2013
Multidrug Resistant Bacteria - Description
P Stogsdill MD FIDSA Sept 2013 Bad bugs No drugs NO ESKAPE E nterococcus faecium S taphylococcus aureus K lebsiella pneumoniae C lostridium difficile A cinetobacter ID: 673800 Download Presentation
LT . Christina Jamros, DO (Associate. ) . CDR . Ryan Maves, MD (Fellow. ) . CAPT . Mary . Bavaro. , MD (Fellow). Department of Internal . Medicine. Naval . Medical Center, San Diego, CA. Disclosure. I have no relevant financial relationships with any commercial supporters..
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Prevention of spread and c ontrol of MD s in health care setting are critical and urgent as the number of antibiotic available to treat these infections is extremely limited and development of new antibiotics is not forthcoming in the foreseeable fu
Key terms used in exam questions. Pathogen. – An microorganism that causes an infectious disease.. Antibiotic. – A chemical that kills . bacteria. .. Antiseptic. – A chemical that is used externally to prevent the spread of pathogens..
Resistance Pattern . in New Mexico. Obi C. Okoli, MD.,MPH.. Clinic for Infectious Diseases. Las Cruces, NM.. Are these the world's sexiest accents?. Are these the world's sexiest accents?. 13. . Argentine.
A2SC Summary provided by. LCDR Thaddus D. Wilkerson. A Roadmap for the Nation. Definition. Vision. Scope. Purpose. Goals. Outcomes. Accountability. National Action Plan Defined. The . National Action Plan for Combating Antibiotic-resistant Bacteria .
Science Starter:. Think of a time when you got really sick. What did you have? What did the doctor give you as medicine?. 1. What things can make you sick?. A . pathogen. is a bacteria, virus, or other microorganism that can cause disease..
update 2011. Between 2011 and 2015 …. Increase in TB cases tested for R & H yearly from 0.8 million to 1.9 million. 1 . million . multidrug-resistant TB (. MDR-TB) . patients detected and put on treatment.