Nosocomial Bacterial Infections in Intensive Care Units- Finale

8/6/2019 Nosocomial Bacterial Infections in Intensive Care Units- Finale

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Nosocomial Bacterial Infections inIntensive Care Units.

I : Organisms and Mechanisms of antibiotic resistance.

Nosocomial Bacterial Infections inIntensive Care Units.

I : Organisms and Mechanisms of antibiotic resistance.

Oleh : Putri Annisa KamilaPembimbing : Dr. Wiwi Jaya , SpAn.

Oleh : Putri Annisa KamilaPembimbing : Dr. Wiwi Jaya , SpAn.



What is Nosocomial

Infection ???infections that are a result of treatment

in a hospital or a healthcare service

unit. Infections are considered

nosocomial if they first appear 48

hours or more after hospital

admission or within 30 days after

discharge



Nosococomial Infection and

ICU...

� Between 5% and 15% of hospital in-patients

develop an infection during their admission .

� Critically ill patients in an intensive care unit (ICU)

are 5±10 times more likely to acquire a

nosocomial infection than those in general wards



Critically ill patients present special

microbiological

features .......



Mechanism of Resistanc



The microorganisms...

GRAM POSITIVE BACTERIA GRAM NEGATIVE BACTERIA

Staphylococcus Aureus Klebsiella spp

Coagulase-Negative-S.Aureus enterobacter

Vancomycin Resistant Enterococci Pseudomonas

Acinetobacter

Stenothropomonas maltophilia



Gram-positive organisms...

Staphylococcus aureus :

�



Colonisation and infection.



Antimicrobial Therapy



Coagulase-negative

staphylococci � coagulase-negative staphylococci are

distinguished from S. aureus by their

inability to clot blood plasma .

� It is a normal commensal at a wide variety

of anatomical sites including mucous

membranes, groin, axillae and exposed

skin surfaces



Infections...

� They are causative organisms in

19% of nosocomial ICUinfections and are by far the

most common pathogen

isolated in catheter-relatedbacteraemia

Dri of Choice : Vancom cin



V ancomycin-resistant

Enterococci



Colonisation and infection ...� There is an association between

colonisation with vancomycin-

resistant Enterococci and the oral or

parenteral use of vancomycin,cephalosporins and anti-anaerobic

drugs (metronidazole, clindamycin

and imipenem)



MultiplicationVancomycin , etc..



Antimicrobial therapy ...

� Ampicillin

� Quinupristin » dalfopristin

� Linezolid

� Chloramphenicol

� Nitrofurantoin



Gram-negative organisms

� Gram-negative bacilli are frequently

associated with nosocomial infections

in ICU patients, particularlyventilator-associated pneumonia

and catheter-associated urinary

tract infections



K lebsiella spp.

� Klebsiella species belong to the familyEnterobacteriaceae that includes Enterobacter spp.,

Escherichia coli, Proteus spp. and Serratia spp.

� nosocomial and are typically opportunistic

� Klebsiella spp. display a particular proclivity for acquiring plasmids.

� possess extended-spectrum betalactamases.



Colonisation and Infection

urinary tract infections,

peritonitis, cholangitis and intra-abdominal

infections.



Drug of choice



Enterobacter.



commonest causes of ventilator-associated pneumonia



plasmid

R esistance and antimicrobial

RESIST ANT

antipseudomonal penicillin » beta-

lactamase inhibitor combination and an

aminoglycoside



VERY HARD TO DISSEMINATE !!!!!



� Known resistance mechanisms includeplasmid-mediated beta-lactamases, whichare also frequently associated withresistance to fluoroquinolones andaminoglycosides .

� imipenem remains the most active agent andis the drug of choice when faced withmultiresistant strains.



S tenotrophomonas

maltophilia

high intrinsic resistance tobeta-lactams

nosocomial pneumonia,bacteraemia, endocarditisand skin and soft tissue

infection

Related to prior antibioticsexposure

Co-trimoxazole remainsactive against most strainsand is the agent of choice



Conclusion..� A significant proportion of patients find their hospital staycomplicated by an infection. Patients in intensive care units

are even more susceptible to nosocomial infections

� The pathogens isolated in this environment are not usuallyencountered elsewhere. In addition, they are frequentlyresistant to many commonly used antibiotics, partly as aresult of antibiotic selective pressure .

� The combined effect of intrinsic and acquired resistance inICU-acquired infections severely limits antibiotic choice,forcing the development and use of newer antibiotics

� Nosocomial infections have an impact on morbidity andprobably on mortality, and pose a significant economicburden

Nosocomial Bacterial Infections in Intensive Care Units- Finale

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