Capstone project multidrug resistant microorganisms
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Multidrug resistant organisms (MDROs) such as carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Staphylococcus aureus (VRSA) have become major health threats as they are resistant to multiple antimicrobial agents. CRE caused over 9,000 infections and 610 deaths annually in the US according to a 2013 report. VRSA infections are difficult to treat due to resistance to vancomycin, the drug of last resort for methicillin-resistant Staphylococcus aureus (MRSA) infections. The overuse and misuse of antibiotics has contributed to the rise of MDROs through selective pressure and gene transfer. Hospitals have implemented antibiotic stewardship and infection control
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Capstone project multidrug resistant microorganisms
- 1. Multidrug Resistant Organisms MDROs Trinh Diep Saint Cloud State University, Capstone Nursing Student
- 2. Antimicrobial Agents Antibiotic Antiviral Antifungal Antiparasitic In the last 70 years, these medications have been used to treat infectious disease.
- 3. Multidrug Resistant Organisms Multidrug resistant organisms (MDROs) are organisms that become resistant to one or several antimicrobial agents. Antimicrobial agents become ineffective against the organism.
- 5. Statistic Report (2013) Carbapenem-resistant Enterobacteriaceae (CRE): 9,300 annual infectious cases and 610 deaths Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLs): 26,000 annual infectious cases and 1,700 deaths • Methicillin-resistant Staphylococcus aureus (MRSA): 80,000 annual infectious cases and 11,000 deaths • Vancomycin-resistant Enterococcus (VRE): 20,000 annual infectious cases and 1,300 deaths • Streptococcus Pneumoniae (full resistance to clinically relevant drugs): 1,200,000 annual infectious cases and 7,000 deaths
- 6. Antibiotic Prescribing Practices 1 in 2 hospital patients receive an antibiotic In some hospitals, doctors prescribe 3 times as many antibiotic as doctors in other hospitals Reducing the use of high-risk antibiotics by 30% can lower GI infections by 26%.
- 7. Causes of Antimicrobial Resistance • Selective pressure • Mutation • Gene transfer • Societal pressure • Inappropriate uses • Inadequate diagnostics • Hospital uses • Agricultural uses
- 8. Extended-Spectrum β-Lactamases (ESBLs) • ESBLs are enzymes produce by some bacteria • Mediate resistance to certain antibiotics: • Extended-spectrum (third generation) • Cephalosporins • Monobactams
- 9. Some latest MDROs or “Super Bugs” • Carbapenem-resistant Enterobacteriaceae (CRE)/ Klebsiella pneumoniae Carbapenemase • Vancomycin resistant Staphylococcus aureus (VRSA) / vancomycin-intermediate Staphylococcus aureus (VISA)
- 10. Carbapenem-resistant Enterobacteriaceae (CRE) • Enterobacteriaceae_ a family of Gram-negative bacteria, commonly found organisms in human gastrointestinal (GI) tract • Klebsiella species • Pneumonia, bloodstream infection, wound or surgical site infection, and meningitis • Escherichia coli (E. coli) • Urinary tract infection • Type of CRE: • Klesiella pneumoniae carbapenemase (KPC) • New Delhi Metallo-beta-lacamase (NDM)_ uncommon in the United States
- 11. CRE infection • High risk patients: • Urinary Catheter • Intravenous Catheter • Ventilator • Long course of certain antibiotics • Compromised immune system •Spread by: •Person to person contact •Contact with wounds, feces, or inanimate objects
- 12. 8 Recommended Core Measures for CRE (Acute and long-term care facilities) • Hand hygiene • Contact Precaution • Healthcare personnel education • Minimize use of invasive device • Patient and staff cohorting • Laboratory notification • Antimicrobial Stewardship • CRE screening
- 13. Vancomycin resistant Staphylococcus aureus (VRSA) / Vancomycin-intermediate Staphylococcus aureus (VISA) • Staphylococcus aureus: • Commonly found on the skin and in the nose • Common infection look like pimple, boils, and other skin conditions • Can be treated
- 14. VRSA/ VISA infection • Serious infection: • Bacteremia • Pneumonia • Endocarditis: infection of heart valve • Osteomyelitis : Bone infection • Toxic Shock Syndrome: • high fever, nausea/vomiting • rash on palm and soles • VRSA/ VISA: Staphylococcus Aureus become resistant to Vancomycin
- 15. VRSA/ VISA infection • Patients’ risk factors: • Diabetes mellitus • Compromised immune system • Surgical wound/ burn • Invasive device • Transmission: • Person to person contact • Contact with inanimate objects • Contact with other person’s wound, skin abrasion
- 16. Treatment and Prevention VRSA/ VISA •Antibiotics •Wound drainage •Removal of invasive device
- 17. Current Antibiotics •Ceftaroline fosamil •Ceftolozane/tazobactam •Carbapenems • Doripenem • Panipenem • Razupenem • Tomopenem
- 19. Hospital Antibiotic Stewardship Programs • Leadership Commitment • Accountability • Drug Expertise • Action • Tracking • Reporting • Education
- 20. Precaution and prevention of VRSA/VISA infection • Contact precaution • Hand hygiene • Cover open wound • Reduce tampon risk • Keep personal items personal
- 21. Hand Hygiene Most effective way to prevent the transmission of microorganism
- 23. SCREENING FOR MDROs SCREEN FOR MDROs !!!
- 24. References • Bassetti, M., Merelli, M., Temperoni, C., & Astilean, A. (2013). New antibiotics for bad bugs: where are we?. Annals of Clinical Microbiology and Antimicrobials, 12 (22). doi: 10.1186/1476-0711-12-22 • Center for Disease Control and Prevention. (2013). Antibiotic resistance threats in the United States. Retrieved from: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013- 508.pdf#page=13 Center for Disease Control and Prevention. (2014). Making health care safer: antibiotic Rx in hospitals: proceed with caution. Retrieved from: http://www.cdc.gov/vitalsigns/antibiotic-prescribing-practices/ • Center for Disease Control and Prevention. (2013). Carbapenem-resistant Enterobacteriaceae (CRE). Retrieved from: http://www.cdc.gov/hai/organisms/cre/
- 25. References • Center for Disease Control and Prevention. (2010). Laboratory detection of extended-spectrum β-Lactamases (ESBLs). Retrieved from: http://www.cdc.gov/hai/settings/lab/lab_esbl.html • Center for Disease Control and Prevention. (2012). 2012 CRE toolkit - guidance for control of Carbapenem-resistant Enterobacteriaceae (CRE). Retrieved from: http://www.cdc.gov/hai/organisms/cre/cre-toolkit/f-level-prevention- supmeasures.html#facility-summary • Center for Disease Control and Prevention. (2014). Core elements of hospital antibiotic Stewardship programs. Retrieved from: http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html National Institution of Allergy and Infectious Disease. (2011). Antimicrobial (drug) resistance. Retrieved from: http://www.niaid.nih.gov/topics/antimicrobialResistance/Understanding/Pages/causes.aspx
Editor's Notes
- _Does not affect Cephamycinsor Carbapenems_Hard to detect since they have different level of activity against various cephalosporins. It is critical to choose the right antimicrobial agent to detect these enzymes.
- _Carbapenem is a broad spectrum antibiotic
- _Acute and long-term facilities
- Ceftaroline fosamilFDA (2010) and European Medical Agency (EMA, 2012) Against: hetero-resistant Vancomycin-intermediate S. Aureus (hVISA)Vancomycin resistant S. Aureus (VRSA) Community Acquired Pneumonia Skin and soft Tissue structure infections (SSTI)Ceftolozane/tazobactamin-vitro activity: good to excellent against some important Gram-negative organisms, such as E. Coli and K. Pneumoniae DoripenemCarbapenem class FDA (2007) approved for treatment of pyelonephritis, complicated urinary tract infection (cUTI) and complicated intra-abdominal infection In Europe, approved for Ventilator-associated pneumoniaE Highly active against Methicilline-susceptible S. Aureus, but not effective against MRSA, VRE.PanipenemE. Coli, Klesiellapnemoniae, and other Enterobateriaceae are highly susceptible to PanipenemRazupenmehas broad-spectrum against MRSA, and extended-spectrum beta-lactamase (ESBL) producing bacteriaTomopenemnew Carbapenem, broad spectrum displays good activity against ESBL-producing Eterobacteriaceae, MRSA
- Aminoglycosidesclass of antibiotic consist of many different agent used alone or as part of combination therapyPlazomicinin-vitro, with Daptomycine and ceftobiprole against MRSA, hVISA, and VISAGlycopeptideseffective mainly gram-positive cocciOritavancinpromising for the treatment of MRSA, VISA, VRSA
- Resource:http://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf Leadership Commitment: Dedicating necessary human, financial and information technology resources Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use. Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours) Tracking: Monitoring antibiotic prescribing and resistance patterns Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff Education: Educating clinicians about resistance and optimal prescribing