G AIMS Staphylococcus aureus lives where? Harmlessly on the skin hands, axilla, groins nose. D f h b d can cause disease if it enters the body, via -cuts, surgical incisions, catheters etc.
G AIMS Staphylococcus aureus lives where? Harmlessly on the skin hands, axilla, groins nose. D f h b d can cause disease if it enters the body, via -cuts, surgical incisions, catheters etc.
G AIMS Staphylococcus aureus lives where? Harmlessly on the skin hands, axilla, groins nose. D f h b d can cause disease if it enters the body, via -cuts, surgical incisions, catheters etc.
Dr. Sushma Krishna, Microbiologist, g AIMS Staphylococcus aureus lives where? Harmlessly on the skin hands, axilla axilla, groins nose. d f h b d Can cause disease if it enters the body, via -cuts, surgical incisions, catheters etc. g Lets hear the antibiotic story. 1929:Penicillin, 1950 1929:Penicillin, 1950 Treatment: Methicillin/oxacillin (MRSA) 1970 B-lactamases Treatment: Methicillin/oxacillin (MRSA), 1970 T tm nt: n m in t >1997 Methicillin Resistant Staphylococcus Aureus(MRSA) Treatment: vancomycin etc, >1997 Vancomycin Resistant Staphylococcus ?/Nephrotoxic/expensive Vancomycin Resistant Staphylococcus aureus (VRSA) METHICILLIN RESISTANT RESISTANT STAPHYLOCOCCUS AUREUS AUREUS Infections caused by MRSA Infections caused by MRSA Nosocomial pneumonia Nosocomial pneumonia surgical site infection CRBSI (li l t d) CRBSI (line-related) UTI Shunt infections Wound infections- cellulitis abscess Wound infections cellulitis, abscess, furuncles, boil, folliculitis Burn infections Burn infections Complication- sepsis, endocarditis etc Transmitted from person to person by direct contact with the skin clothing or direct contact with the skin, clothing, or area (for example, sink, bench, bed, and utensil) that had recent physical contact ) p y with a MRSA-infected person. Diagnosed by -culture , PCR/molecular g y , methods if outbreak suspected. MRSA are usually resistant to multiple y p antibiotics. Need to have antibiotic susceptibility p y determined to choose the correct or appropriate antibiotic therapy. Skin organisms, Skin organisms, Contaminated catheter hub 1 Endogenous Skin flora Extrinsic HCW hands Skin Vein Fibrin sheath, thrombus Hematogenous from distant infection Why worry about MRSA? What can be done? GET MOTIVATED TO PREVENT IT 1) Infection control ) Hand-washing before, between, after patient contact Improve overall standards of h ( d ) p hygiene (ward matron) Treat MRSA patients in isolation or cohort S th MRSA i f Screen the MRSA carriers of staff, decontaminate them avoiding skin contact with i f t d l it infected people or items they have touched MRSA prevention contd- MRSA prevention contd Wear disposable gloves, p g gowns, and masks when treating or visiting hospitalized MRSA p patients. Cover skin abrasions and minor lacerations minor lacerations immediately Reduce bacterial resistance: - resistance: Stop over-prescription of antibiotics Always finish course of Always finish course of antibiotics Enterococci story. Treatment: Penicillin/Ampicillin reatment Pen c ll n/Amp c ll n Treatment: Vancomycin B-lactamases Treatment: Vancomycin Vancomycin ? Resistant Enterococci(VRE) Where does VRE live in hospital? Where does VRE live in hospital? Infections caused by VRE Infections caused by VRE CA- Urinary tract infection CA Urinary tract infection CRBSI P th ti l I f ti d diti Prosthetic valve Infective endocarditis Surgical site infections, Wound infections Enterococci live in the gut, although they can cause infection anywhere in the body infection anywhere in the body. VRE spreads from person to person Western data- about 30% of all enterococcal infections are now caused by vancomycin-resistant strains (VRE). They are inherently resistant to several antibiotics They are inherently resistant to several antibiotics Vancomycin resistance is acquired when a sensitive Enterococcus acquires a special piece of DNA called a plasmid The new strain is called vancomycin resistant plasmid. The new strain is called vancomycin-resistant enterococci (VRE). VRE appears able to transfer vancomycin resistance t l t d b t i h MRSA ( thi illi to unrelated bacteria such as MRSA (methicillin- resistant Staphylococcus aureus). EMERGENCE OF DRUG RESISTANCE RESISTANCE Susceptible bacteria Resistance gene transfer Resistant bacteria Newresistant bacteria New resistant bacteria Lancet Infect Dis , 2001;1(5): 31432 GN Multi Drug Resistant i (MDR) organsims (MDR) Gram negative bacteria with i 2/3 l f d resistance to 2/3 class of drugs are MDRs MD (E.coli,Pseudomonas,Klebsiella,etc.) Most of the hospital strains are MDR. Who gets gram negatives MDR i f i ? infection? Long term antibiotic exposure Long term antibiotic exposure Prolonged ICU stay Severe illness-immunocompromised Residence in an institution with high Residence in an institution with high rate of 3 rd generation h l i cephalosporins use. Instrumentation / catheterization Gram negative MDR s Treatment: Penicillin/Ampicillin Ceftriaxone/cefuroxime/cefta/ cefa-sulb/pip-tazo etc Beta lactamases Ceftriaxone/cefuroxime/cefta/ cefa sulb/pip tazo etc Imipenem/Meropenem Extended spectrum beta lactamases(ESBL) Imipenem/Meropenem Carbapenemases, Metalo- beta colistin/Tigecycline lactamases(MBL) ? Transmission Precautions Transmission Precautions Hand Washing Hand Washing PPE Minimum Traffic Care of equipment & articles Limit Transport Limit Transport Handling soiled linen g Cleaning PREVENTION PREVENTION Limit high rate of 3rd generation Limit high rate of 3rd generation Cephalosporin use Follow standard precautions F p Contact, droplet, airborne isolation precautions p Cleaning and disinfection of touched surfaces Provide data and watch the incidence rates r ata an watch th nc nc rat Share your experience- Increase awareness among HCW. g ESBL detection, Gram negative bacteria Representation of emerging healthcare- associated infections over time associated infections over time Herwaldt LA, Wenzel RP. Dynamics of hospital-acquired infections Acinetobacter Acinetobacter. .. ICU nightmare- endemic! Rapidly emerging pathogen in the health care setting, Survives under a wide range of environmental conditions Lives for extended periods of time on surfaces Frequent cause of outbreaks of infection Resistant to all antibiotics (colistin Tigecycline Resistant to all antibiotics (colistin, Tigecycline, levo) Diseases caused- VAP Wound infections Wound infections Bacteremia, septicemia Urinary tract infections Lets understand. Methods for control and prevention of multidrug- resistant Acinetobacter infection. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. I f the red x still appears, you may have to delete the image and then insert it again. Eliopoulos G M et al. Clin Infect Dis. 2008;46:1254-1263 What does a microbiology report f ll h b ? of all these superbugs mean? Is it named? m Call ICT, inform Ask doc colonization or infection? Colonization needs good nursing, not antibiotics Follow VAP bundles/CRBSI/all bundles, protocols Prevent cross-transmission- follow standard and isolation precautions and isolation precautions Clean your environment Disinfect surfaces & places regularly and Disinfect surfaces & places regularly and promptly