2. INTRODUCTION
Rehabilitation clinics, and long-term care, could be factors by which people
acquirable some types of bacteria. In this article it´ll explain acquisition with C.
difficile and extended-spectrum B-lactamase-producing Enterobacteriaceae
(ESBL-E)
• Clostridium difficile: Is a
Clostridium gender bacteria. Only
in a few percent of people, this
bacteria is normal and does not
cause any problem. By the way, it
is the most common cause of
pseudomembranous colitis.
It is treated with metronidazole:
antibiotic and antiparasitic.
• Beta-lactamase: Are enzymes
produced by bacteria in order
to get resistance against any
antibiotic. This enzyme
breaks the B-lactam ring
open, deactivating the active
center´s antibiotic.
3. INTRODUCTION
• Clostridium difficile + Resistance: The first-line drugs for the
treatment of C. difficile are metronidazole and vancomycin. Oral
treatment with metronidazole is usually well tolerated, although
systemic effects may appear. Vancomycin is currently
considered the second line of treatment. It can be administered
orally, including the nasogastric tube, or rectally in enemas
4. INTRODUCTION
Leve - moderado Menos de 6 deposiciones al
día Leucocitosis < 15000/mm
3
Severo Diarrea profusa (> 6
deposiciones al día) Que
desarrolle en el curso de la
diarrea:•Leucocitosis
>15.000/mm
3
•Dolor abdominal (no
abdomen agudo)
•Hipoalbuminemia (albúmina
< 3 gr/dl)
Severo complicado ICD severa asociada a:
(7)•Ingreso a unidad de
paciente crítico
•Hipotensión con o sin DVA
•Fiebre > 38,5 °C
•Ileo
•Compromiso de conciencia
•Leucocitosis >35.000/mm
3
o
< 2.000 /mm
3
•Lactato > 2,2 mmlo/lt
•Cualquier evidencia de falla
de órgano
Classification according to the severity
Pseudomembranous colitis
5. OBJETIVE
• This study investigated the frequency of
intestinal colonization by these
pathogens (Clostridium difficile or
extended-spectrum b-lactamase-
producing Enterobacteriaceae (ESBL-E))
among patients in rehabilitation clinics of
different specialization.
7. METHODS
• POLYMERASE CHAIN
REACTION (PCR): Is a
method based on the
ability of the DNA
polymerase to
synthesize new strand
band of DNA
complementary to the
offered templated strand.
8. METHODS
• PLASMID-MEDIATED QUINOLONE RESISTENCE (PMQR): Three
mechanisms for plasmid-mediated quinolone resistance (PMQR) have
been discovered. Plasmid genes qnrA, qnrB, qnrC, qnrD,
qnrS, and qnrVC code for proteins of the pentapeptide repeat family that
protects DNA gyrase and topoisomerase IV from quinolone inhibition.
The qnr genes appear to have been acquired from chromosomal genes
in aquatic bacteria, are usually associated with mobilizing or transposable
elements on plasmids, and are often incorporated into sul1-type integrons.
The second plasmid-mediated mechanism involves acetylation of
quinolones with an appropriate amino nitrogen target by a variant of the
common aminoglycoside acetyltransferase AAC(6′)-Ib. The third
mechanism is enhanced efflux produced by plasmid genes for pumps
QepAB and OqxAB.
9. METHODS
• Pulsed field gel electrophoresis (PFGE): Using this technique,
we separate large chromosomal DNA fragments by means of a
special electrophoresis technique, in which electric fields with
pulsating incidence are applied, the larger the fragments are,
the longer the applied fields.
• It is used to identify genetically, the differences between
Clostridium strains.
*These were the studied genes: (blaTEM-like, blaSHV-
like, blaCTX-M-1-2-9-group, blaOXA-1-group, blaCMY-
like, blaCMY-like, blaDHA-like, blaKPC-like, blaOXA-48-
like, blaVIM-like, and blaNDM-like)
13. DISCUSSION
AUTHOR WHAT HE SAID YES OR NOT
Drody D, Fanning S In the present study, all ribotype 017 isolates
were collected in one clinic, where this strain
accounted for ~50% of the toxigenic isolates.
Ribotype 017 has been associated with
outbreaks and severe infections in hospitals in
the Netherlands and other countries
Arvand M, Bettge-Weller,
Harmanus C
The most frequent C. difficile ribotypes were 014,
017, 001, and 078 in this study. In contrast to
ribotypes 014, 001, and 078, which occur
frequently in hospitals and nursing homes in Ger-
many, ribotype 017 is rare in this region
Valenza G, Pietsch M, Arvand M The presence of distinct E. coli clones in more
than one patient in a distinct clinic further
confirms the possibility of clonal spread within
the fa-cilities. In general, we found a variety of
different ESBL-E clones but only a few E. coli
ST131 isolates as compared to previous studies
in nursing homes in Germany
Arvand M, Witte W, Bettge-
Weller.
For instance, our strain collection comprising
about 500 C. difficile isolates, mainly from
Southwest Germany between 2008 and 2015,
contains only two other ribotype 017 isolates,
which were isolated from patients with severe C.
difficile infection in 2008
14. CONCLUSIONS
• In this article, we can infer that multidrug-resistance bacteria, is
a huge health public problem, which is causing a lot of dead
around the world; because one strain can easily mutate its
genus in order to become immune to antibiotics. So two
bacteria of the same family as the E.coli can be resistant to
different medications.
• Depending of the facility, doctors and health staff be must very
careful with the types of bacteria in the environment, in order to
choose the best treatment in the patient.
