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Bacterial animation and management
- 1. BACTERIAL ANIMATION AND MANAGEMENT 2 SAMIR EL ANSARY ICU PROFESSOR AIN SHAMS CAIRO elansarysamir@yahoo.com
- 2. Global Critical Care https://www.facebook.com/groups/1451610115129555/#!/groups/145 1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY
- 4. Health Care-Associated Infection (HAI) * Hospital acquired infection * Nosocomial infection
- 5. Health Care-Associated Infection (HAI) 3 • Localized or systemic condition resulting from an adverse reaction to the presence of an infectious agent(s) or its toxin(s) • There must be no evidence that the infection was present or incubating at the time of admission to the hospital • For most bacterial infections, this means that the infection usually become evident 48 hours (the typical incubation period) or more after admission
- 6. Health Care-Associated Infection (HAI) 4 Because the incubation period varies with - the type of pathogen - the patient’s underlying condition Each infection must be assessed individually for evidence that links to the hospitalization
- 7. Health Care-Associated Infection (HAI) 5 May be caused by infectious agents from • Endogenous sources :- skin, nose, GI tract or vagina that are normally inhabited by microorganisms •Exogenous sources :- patient care personnel, visitors, patient care equipment, medical devices or health care environment
- 8. BACTERIA Acinetobacter baumannii Pseudomonas aeruginosa Klebsiella pneumoniae Staphylococcus aureus (MRSA) No culture & no growth NOSOCOMIAL BACTERIA ISOLATED FROM VAP VAP : Ventilator associated pneumonia 8
- 10. Cell Wall of Gram-Negative Bacteria 12
- 11. Physiologic Action of LPS from the Gram- Negative Cell Wall 13
- 12. Animation :Physiologic Action of LPS 14
- 13. Antibacterial drugs % Susceptibility Trimethoprim- sulfamethoxazole 44 Gentamicin 79 Amikacin 99 Percentage of Susceptible E. coli Isolated from All Clinical Specimens 15
- 14. Antibacterial drugs % Susceptibility Trimethoprim-sulfamethoxazole 44 Gentamicin 79 Amikacin 99 Amoxicillin-clavulanic acid 85 Percentage of Susceptible E. coli 15 Clavulanic acid : b-lactamase inhibitor
- 15. Antibacterial drugs % Susceptibility Trimethoprim-sulfamethoxazole 44 Gentamicin 79 Amikacin 99 Amoxicillin-clavulanic acid 85 Cefotaxime 96 Ceftazidime 96 Cefepime 98 Imipenem 100 Meropenem 100 Ofloxacin 51 Percentage of Susceptible E. coli 15
- 16. Extended-Spectrum b–Lactamase (ESBL) •penicillins, cephalosporins b-lactamase inhibitor :- clavulanic acid 17
- 17. Antibacterial drugs % Susceptibility Trimethoprim-sulfamethoxazole 25 Gentamicin 35 Amikacin 95 Amoxicillin-clavulanic acid 47 Cefotaxime 0 Cefoperazone-sulbactam 0 Cefepime 0 Imipenem 100 Meropenem 100 Ofloxacin 18 Percentage of Susceptible E. coli ESBL producing 16
- 19. Phagocytosis Blocked by Capsule (Animation) 19
- 20. •Enterotoxin) •Urinary tract infection (UTI) K. pneumoniae 20 K. pneumoniae producing ESBL
- 21. • Aerobic gram-negative bacilli, non-spore forming • Grape-like odor •Saprophyte (soil, water) • Pyocyanin pigment •Intestinal flora Pseudomonas aeruginosa •Opportunistic pathogen 21
- 22. 23
- 23. Virulence factors Alginate (slime layers, biofilm) (polymer of mannuronic & glucuronic acid) • Prevent phagocytosis • Adhere to epithelial cells 24
- 24. Clinical manifestation of P. aeruginosa infections 25
- 25. Antibacterial drugs % Susceptibility Colistin 100 Gentamicin 71 Amikacin 76 Piperacillin-tazobactam 83 Cefoperazone-sulbactam 69 Ceftazidime 67 Cefepime 69 Imipenem 69 Meropenem 72 Ciprofloxacin 69 Percentage of Susceptible P. aeruginosa 27
- 26. Acinetobacter • Aerobic gram-negative coccobacilli, non-spore forming • > 25 species •A. baumannii is the most common cause of ventilator- associated pneumonia (VAP) •Opportunistic pathogen
- 27. A. baumannii Clinical manifestation of A. baumannii infection 1.Hospital-acquired pneumonia especially VAP 2.Community-acquired pneumonia :The source of infection may be throat carriage, which occurs in 10% of community residents with excessive alcohol consumption 3.Bloodstream infection & endocarditis 4.Skin/soft tissue infection 5.UTI 6.Meningitis 29
- 28. Antibacterial drugs % Susceptibility Colistin 99 Gentamicin 25 Amikacin 28 Cefoperazone-sulbactam 31 Ceftazidime 23 Cefepime 21 Imipenem 26 Meropenem 27 Ciprofloxacin 23 Percentage of Susceptible A. baumannii 30
- 29. A. baumannii Persistence in the hospital environment : 3 days to 5 months 1. Resistance to major antimicrobial drugs 2. Resistance to desiccation 3. Resistance to disinfectant Three factors contributing to the persistence : 31
- 30. STAPHYLOCOCCUS
- 33. 3. Hyaluronidase (Spreading factor) Hyaluronidase digests hyaluronic acid, the “glue” that holds cells together 37
- 34. Clinical manifestation of S. aureus infection 38
- 35. Antibacterial drugs % Susceptibility Trimethoprim-sulfamethoxazole 99 Oxacillin 100 Erythromycin 93 Clindamycin 93 Vancomycin 100 Fosfomycin 88 Percentage of Susceptible S. aureus (MSSA) 39
- 36. 40
- 37. Antibacterial drugs % Susceptibility Trimethoprim-sulfamethoxazole 9 Oxacillin 0 Erythromycin 1 Clindamycin 2 Vancomycin 100 Fosfomycin 76 Percentage of Susceptible S. aureus (MRSA) 42
- 38. Enterococci • Gram-positive cocci in chain 44
- 39. Enterococci • Gram-positive cocci in chain • Commensals of the GI tract of humans & animals • Diseases : • Consist of 16 species :- E. faecalis, E. faecium - Urinary tract infection (UTI) - Bacteremia, endocarditis 44
- 40. Antibacterial drugs % Susceptibility Tetracycline 6 Penicillin 9 Ampicillin 10 Vancomycin 99 Levofloxacin 11 Percentage of Susceptible E. faecium 45
- 42. VRE Transmission Health care settings Community settings Colonization of discharged patients with VRE Discharge Colonization of individuals Colonization of patient Admission Colonization & transmission among food producing animals effects by Avoparcin / Glycopeptide Ingestion Household transmission Colonization or infection identified due to selective antimicrobial pressure and/or underlying illness Health care transmission Worker hands Environment 48
- 43. BACTERIA Duration of persistance (range) Acinetobacter spp. 3 days to 5 months Clostridium difficile (spores) 5 months Escherichia coli 1.5 hours -16 months Enterococcus spp.including VRE and VSE 5 days - 4 months Klebsiella spp. 2 hours to >30 months Mycobacterium tuberculosis 1 day - 4 months Pseudomonas aeruginosa 6 hours -16 months; on dry floor : 5 weeks Staphylococcus aureus, including MRSA 7 days - 7 months Persistence of nosocomial bacteria on dry inanimate surfaces 49
- 44. Contaminated inanimate surface Susceptible patient Hands of healthcare worker Direct transmission Common Modes of Transmission from Inanimate Surfaces to Patients 50 Compliance in hand hygiene:~50%
- 45. 1. Transduction 2. Conjugation 3. Transformation
- 46. Attachment 1 2 3 Phage DNA is injected into bacterial cell Multiplication Assembly with some mistake Generalized Transduction by Lytic Phage (1)
- 47. Generalized Transduction (2) Bacterial cell is broken to release progeny phages 4 5 Phage carrying donor DNA infects another bacterium (recipient) 53
- 48. Generalized Transduction (3) 6 7 Genetic exchangeDonor bacterial DNA is injected into recipient cell Any piecies of the DNA of the donor cell can be transferred 3 54
- 50. Conjugation by Sex Pilus 56
- 52. Transformation : transfer naked DNA
- 54. GOOD LUCK SAMIR EL ANSARY ICU PROFESSOR AIN SHAMS CAIRO elansarysamir@yahoo.com Global Critical Care https://www.facebook.com/groups/1451610115129555/#!/groups/145 1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY