Multidrug Resistant OrganismsMDROs

Trinh Diep

Saint Cloud State University, Capstone Nursing Student

Antimicrobial Agents

Antibiotic Antiviral Antifungal Antiparasitic In the last 70 years, these medications have been used to treat infectious disease.

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.

Statistics Report (2013)

2,049,442 illnesses

23,000 deaths

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

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%.

Causes of Antimicrobial Resistance• Selective pressure•Mutation• Gene transfer• Societal pressure• Inappropriate uses• Inadequate diagnostics• Hospital uses• Agricultural uses

Extended-Spectrum β-Lactamases (ESBLs)

• ESBLs are enzymes produce by some bacteria

•Mediate resistance to certain antibiotics:• Extended-spectrum (third generation)• Cephalosporins• Monobactams

Some latest MDROs or “Super Bugs”

• Carbapenem-resistant Enterobacteriaceae (CRE)/ Klebsiella pneumoniae Carbapenemase•Vancomycin resistant Staphylococcus aureus (VRSA) /

vancomycin-intermediate Staphylococcus aureus (VISA)

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

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

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

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

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

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

Treatment and Prevention VRSA/ VISA

•Antibiotics•Wound drainage•Removal of invasive device

Current Antibiotics

•Ceftaroline fosamil

•Ceftolozane/tazobactam

•Carbapenems•Doripenem• Panipenem•Razupenem• Tomopenem

Current Antibiotics

•Aminoglycosides

•Plazomicin

•Glycopeptides

•Oritavancin

Hospital Antibiotic Stewardship Programs

• Leadership Commitment•Accountability•Drug Expertise•Action• Tracking• Reporting• Education

Precaution and prevention of VRSA/VISA infection

• Contact precaution•Hand hygiene• Cover open wound• Reduce tampon risk•Keep personal items personal

Hand Hygiene

Most effective way to prevent the transmission

of microorganism

Contact Precaution

SCREENING FOR MDROs

SCREEN FOR MDROs

!!!

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/

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