Control of multi-drug resistant micro-organisms

1. Control
of
MDRO
November
2012
MRSA
MREBC
ESBL Quinolone Aminogly Carba- Cotrim-
n o-siden penem oxazol
VRE
ESBL
E. coli A B* B* A nvt
PRP
CRPSA
VRSA
Klebsiell A B* B* A nvt
PNSP
a spp
MRCNS
MDRTB
C-­‐MRSA
ABRT
CRAB
Overige A B* B* A B*
VISA
QREB
CRPSA
IsolaAe
bij
resistenAe
van:
A=enkel
B=tenminste
twee
C=tenminste
drie
CAZ Quinol AG Penem PIP Cotrim
Acineto- B B B A nvt nvt
bacte
r spp
S.malto- nvt nvt nvt nvt nvt A
philia
Overige C C C C C nvt
A=single
B=at
leats
two
C=at
least
three
Andreas
Voss,
MD,
PhD
1

2. Control
of
MDRO
November
2012
What
is
the
clinical
impact
of
ESBLs?
ESBL
AnAbioAcs
RetrospecAve
Cohort,
198
pt
bacteremia:
¤ Emperical
treatment
of
severe
community
ESBL
predictor
of
mortality
(Schwaber,
K-­‐1587)
infecAons
(3rd
gen.
ceph)
frequently
RetrospecAve,
177
pt
bacteremia:
ineffecAvefail
(1)
ESBL
predictor
of
mortality
BUT
NOT
INDEPENDENT
¤ Inadequate
therapy/delay
of
effecAve
(Bhavnani,
K-­‐1588)
treatment
is
associated
with
increased
Case-­‐Control,
72-­‐72
pt
bacteremia:
mortality
(2)
ESBL
predictor
of
mortality,
(Pena,
K-­‐1585)
¤ Increased
used
of
carbapenems
will
lead
to
increased
carbapem
resistance
(3)
ICAAC
2004
1. Paterson et al. Clin Infect Dis 2004 2. Schwaber et al. J Antimicrob Chemother 2007 3. Schwaber et al. J Antimicrob Chemother 2007
¤
Gloves
¤
Screening
¤
Gowns
¤
AnAbioAc
¤
Masks
Stewardship
¤
New
strategies
¤
Caps
² Are
all
MDRM
the
¤
Goggles
same?
¤
Private
WC
²
MRSA
vs
VRE
²
ESBL
ESCO
vs
KLSP
¤
Single
room
²
horizontal
vs.
¤
CohorAng
verAcal
Andreas
Voss,
MD,
PhD
2

3. Control
of
MDRO
November
2012
¤
PaAents
Hands
Gloves
Gowns
Mask
Goggles
Priv
WC
Single
R
Isol.
R
²
On-­‐admission
MRSA
+
-­‐
² General
versus
selected
(high-­‐risk)
+
VRE
-­‐
²
When
other
paAent
found
MDRM+
ESBL-­‐ +
-­‐
¤ Room
mates
coli
ESBL-­‐
² “unexpected”
MDRM-­‐pos
paAent
+
-­‐
Kleb
¤
HCWs?
Noro
+
-­‐
²
Yes,
MRSA
XDR-­‐Tb
+
+
²
No,
ESBL
and
VRE
If you use it – you loose it!
Europe
738.000.000
inhabitants
Europe
Netherlands
16.000.000
inhabitants
Don’t turn antibiotics
into your daily bread ²
Are
all
MDRM
the
same?
²
Different
species
Andreas
Voss,
MD,
PhD
3

4. Control
of
MDRO
November
2012
Micro-organism Department “outbreak” ²
Are
all
MDRM
the
same?
incl. IC ²
Different
species
Enterobacteriacae Contact * Contact/droplet in ²
Different
virulence
MRSA
vs
VRE
single room or cohort
Acinetobacter Strict Strict
S. maltophilia Contact * Contcat/droplet
Overige Contact * Contact/droplet in
Nonfermenters single room or cohort
MRSA
VRE
incl. PSAE
²
Same
measures
despite
the
different
virulence?
* plus droplet during respiartory care
²
Are
all
MDRM
the
same?
²
PrevenAon:
verAcal
versus
horizontal
approach
²
Different
species
²
Different
virulence
MRSA
vs
VRE
²
Different?
ESBL
E.
coli
HAI
prevenAon
ESBL
KLSP
June
25-­‐28,
2013
Geneva
Switzerland
www.icpic2013.com
Andreas
Voss,
MD,
PhD
4

5. Control
of
MDRO
November
2012
“We
appreciate
you
reading
&
ciAng
ARIC
and
welcome
your
manuscripts”
Andreas
Voss,
MD,
PhD
5