capstone project multidrug resistant microorganisms
TRANSCRIPT
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Multidrug Resistant OrganismsMDROs
Trinh Diep
Saint Cloud State University, Capstone Nursing Student
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Antimicrobial Agents
Antibiotic Antiviral Antifungal Antiparasitic In the last 70 years, these medications have been used to treat infectious disease.
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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.
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Statistics Report (2013)
2,049,442 illnesses
23,000 deaths
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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
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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%.
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Causes of Antimicrobial Resistance• Selective pressure•Mutation• Gene transfer• Societal pressure• Inappropriate uses• Inadequate diagnostics• Hospital uses• Agricultural uses
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Extended-Spectrum β-Lactamases (ESBLs)
• ESBLs are enzymes produce by some bacteria
•Mediate resistance to certain antibiotics:• Extended-spectrum (third generation)• Cephalosporins• Monobactams
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Some latest MDROs or “Super Bugs”
• Carbapenem-resistant Enterobacteriaceae (CRE)/ Klebsiella pneumoniae Carbapenemase•Vancomycin resistant Staphylococcus aureus (VRSA) /
vancomycin-intermediate Staphylococcus aureus (VISA)
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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
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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
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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
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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
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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
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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
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Treatment and Prevention VRSA/ VISA
•Antibiotics•Wound drainage•Removal of invasive device
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Current Antibiotics
•Ceftaroline fosamil
•Ceftolozane/tazobactam
•Carbapenems•Doripenem• Panipenem•Razupenem• Tomopenem
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Current Antibiotics
•Aminoglycosides
•Plazomicin
•Glycopeptides
•Oritavancin
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Hospital Antibiotic Stewardship Programs
• Leadership Commitment•Accountability•Drug Expertise•Action• Tracking• Reporting• Education
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Precaution and prevention of VRSA/VISA infection
• Contact precaution•Hand hygiene• Cover open wound• Reduce tampon risk•Keep personal items personal
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Hand Hygiene
Most effective way to prevent the transmission
of microorganism
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Contact Precaution
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SCREENING FOR MDROs
SCREEN FOR MDROs
!!!
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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/
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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