MDRM (ICAN-ISC workshop)

5
Control of MDRO November 2012 Andreas Voss, MD, PhD 1 MRSA VRE PNSP ESBL CRPSA MREBC PRP CRAB VRSA MDRTB VISA CMRSA ABRT CRPSA QREB MRCNS ESBL Quinolone n Aminogly o-siden Carba- penem Cotrim- oxazol E. coli A B* B* A nvt Klebsiell a spp A B* B* A nvt Overige A B* B* A B* IsolaAe bij resistenAe van: A=enkel B=tenminste twee C=tenminste drie CAZ Quinol AG Penem PIP Cotrim Acineto- bacte r spp B B B A nvt nvt S.malto- philia nvt nvt nvt nvt nvt A Overige C C C C C nvt A=single B=at leats two C=at least three

description

Control of multi-drug resistant micro-organisms

Transcript of MDRM (ICAN-ISC workshop)

Page 1: MDRM (ICAN-ISC workshop)

Control  of  MDRO   November  2012  

Andreas  Voss,  MD,  PhD   1  

MRSA  

VRE  

PNSP  

ESBL  

CRPSA  

MREBC  

PRP  

CRAB  

VRSA  

MDRTB  

VISA  

C-­‐MRSA  ABRT  

CRPSA   QREB  

MRCNS  

ESBL Quinolonen

Aminoglyo-siden

Carba-penem

Cotrim-oxazol

E. coli A B* B* A nvt Klebsiell

a spp A B* B* A nvt

Overige A B* B* A B*

IsolaAe  bij  resistenAe  van:          A=enkel                B=tenminste  twee            C=tenminste  drie  

CAZ Quinol AG Penem PIP Cotrim Acineto-

bacter spp

B B B A nvt nvt

S.malto-philia nvt nvt nvt nvt nvt A

Overige C C C C C nvt

                                                     A=single                B=at  leats  two                          C=at  least  three  

Page 2: MDRM (ICAN-ISC workshop)

Control  of  MDRO   November  2012  

Andreas  Voss,  MD,  PhD   2  

ESBL   AnAbioAcs  

What  is  the  clinical  impact  of  ESBLs?    

RetrospecAve  Cohort,  198  pt  bacteremia:  ESBL  predictor  of  mortality  (Schwaber,  K-­‐1587)  

RetrospecAve,  177  pt  bacteremia:  ESBL  predictor  of  mortality  BUT  NOT  INDEPENDENT  (Bhavnani,  K-­‐1588)  

Case-­‐Control,  72-­‐72  pt  bacteremia:  ESBL  predictor  of  mortality,  (Pena,  K-­‐1585)  

ICAAC  2004  

¤ Emperical  treatment  of  severe  community  infecAons  (3rd  gen.  ceph)  frequently  ineffecAvefail  (1)  

¤ Inadequate  therapy/delay  of  effecAve  treatment  is  associated  with  increased  mortality  (2)  

¤ Increased  used  of  carbapenems  will  lead  to  increased  carbapem  resistance  (3)  

 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  ¤   Gowns  ¤   Masks  ¤   Caps  ¤   Goggles  ¤   Private  WC  ¤   Single  room  ¤   CohorAng  

¤   Screening  ¤   AnAbioAc      Stewardship  

¤   New  strategies  ² Are  all  MDRM  the      same?  ²   MRSA  vs  VRE  ²   ESBL  ESCO  vs  KLSP  

²   horizontal  vs.        verAcal  

Page 3: MDRM (ICAN-ISC workshop)

Control  of  MDRO   November  2012  

Andreas  Voss,  MD,  PhD   3  

Hands   Gloves   Gowns   Mask   Goggles   Priv  WC   Single  R   Isol.  R  

MRSA   +   -­‐  

VRE   +     -­‐  

ESBL-­‐coli  

+     -­‐  

ESBL-­‐Kleb   +   -­‐  

Noro   +   -­‐  

XDR-­‐Tb   +   +  

   

¤   PaAents  ²   On-­‐admission  

² General  versus  selected  (high-­‐risk)  ²   When  other  paAent  found  MDRM+  

¤ Room  mates  ² “unexpected”  MDRM-­‐pos  paAent  

¤   HCWs?  ²   Yes,  MRSA  ²   No,  ESBL  and  VRE  

Europe  

If you use it – you loose it!

Europe  738.000.000  inhabitants    Netherlands      16.000.000  inhabitants  

Don’t turn antibiotics into your daily bread

²   Are  all  MDRM  the  same?  ²   Different  species    

Page 4: MDRM (ICAN-ISC workshop)

Control  of  MDRO   November  2012  

Andreas  Voss,  MD,  PhD   4  

* plus droplet during respiartory care

Micro-organism Department incl. IC

“outbreak”

Enterobacteriacae Contact * Contact/droplet in single room or cohort

Acinetobacter Strict Strict

S. maltophilia Contact * Contcat/droplet

Overige Nonfermenters incl. PSAE

Contact * Contact/droplet in single room or cohort

²   Are  all  MDRM  the  same?  ²   Different  species  ²   Different  virulence  MRSA  vs  VRE              

²   Same  measures  despite  the  different  virulence?  MRSA                  VRE      

²   Are  all  MDRM  the  same?  ²   Different  species  ²   Different  virulence  MRSA  vs  VRE  ²   Different?    

  ESBL  E.  coli  ESBL  KLSP  

²   PrevenAon:  verAcal  versus  horizontal  approach  

HAI  prevenAon  

June  25-­‐28,  2013  Geneva  Switzerland  

   

www.icpic2013.com  

Page 5: MDRM (ICAN-ISC workshop)

Control  of  MDRO   November  2012  

Andreas  Voss,  MD,  PhD   5  

“We  appreciate  you  reading  &  ciAng  

ARIC  and  welcome  your  manuscripts”