Multiresistant bacteria

Multiresistant bacteria in conflict between theory and practice 16th September 2011, Düsseldorf Old and new insights into multiresistant bacteria ,[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

16.09.2011 - MRE - Düsseldorf Deaths (per 100 000 citizens) due to infection in the U.S.A., 1900-1996 Influenza Pandemic First use of penicillin

[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Multiresitant bacteria 2010 16.09.2011 - MRE - Düsseldorf

Causes of MRB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

16.09.2011 - MRE - Düsseldorf Rate of multiresistant bacteria per 1,000 patient days

Increase in resistance through use of antibiotics ,[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Increase in resistance through antibiotic use ,[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

A common wrong interpretation: ,[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

16.09.2011 - MRE - Düsseldorf Basic principle of MRB MRB are not different from bacterial infections apart from by their RESISTANCE TO ANTIBIOTICS This means: - They transfer from person to person easily - They are capable of surviving (epidemic MRSA strains)? - Disinfection treatments have limitations *Discussion: Is MRSA connected to increased virulence?

[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eskape 16.09.2011 - MRE - Düsseldorf

MRSA-related deaths in Intensive Care Units ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Profile: MRSA / MRSE ,[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

MRSA in Germany (2008) ,[object Object],16.09.2011 - MRE - Düsseldorf 2006 2007 2008 Ciprofloxacin 93.8 97.8 91.1 Moxifloxacin - 94.4 89.6 Clindamycin 65.4 72.0 73.4 Gentamycin 13.3 9.8 10.5 Oxytetrazyklin 7.4 6.8 7.8 Rifampicin 2,5 1,1 0.4 Cotrimoxazol 3.1 2.0 10.8 Fosfomycin 3.3 0.6 1.1 Linezolid 0.04 0.11 0.1 Muporizin 2.6 3.3 5.3

MRSA and other multiresistant bacteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New data from MRSA screening 16.09.2011 - MRE - Düsseldorf

16.09.2011 - MRE - Düsseldorf Reduction of nosocomial MRSA infections after the introduction of MRSA screening with the LightCycler MRSA advanced test in the Southwest clinical network, Germany (colours correspond with areas within the network), Number of ha-MRSA infections/colonisations New screening implemented

An increased risk for an MRSA colonisation in line with RKI* recommendations exists for: ,[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf * Robert Koch Institute, Germany

An increased risk for an MRSA colonisation in line with RKI recommendations exists for: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

The microbiological screening rules include: - A swab of the nose, mouth and - A swab of wounds if necessary 16.09.2011 - MRE - Düsseldorf If the MRSA results are positive (ICD-10: U 80.0): Take hygiene measures (see text) Recommended measures include isolation If the MRSA results are negative: Standard hygiene practices Source: Epi. Bull. 46/2004

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New MRSA results (Results of a survey from the DGKH* and the BVÖGD**, Autumn 2010) 16.09.2011 - MRE - Düsseldorf *Deutsche Gesellschaft f ür Krankenhaushygiene (German Society for Hospital Hygiene) **Bundesverband der Ärztinnen und Ärzte des Öffentlichen Gesundheitsdienstes (German Federal Association of Doctors in the Public Health Service)

[object Object],[object Object],[object Object],[object Object],New MRSA results (Results of a survey from the DGKH and the BVÖGD, Autumn 2010) 16.09.2011 - MRE - Düsseldorf *Kommision f ür Krankenhaushygiene und Infektionsprävention (The Commission for Hospital Hygiene and Infection Control)

[object Object],[object Object],[object Object],[object Object],New MRSA results (Results of a survey from the DGKH and the BVÖGD, Autumn 2010) 16.09.2011 - MRE - Düsseldorf

MRSA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

MRSA and other multiresistant bacteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Psychological aspects of isolation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf C. Hartmann: Wie erleben Patienten die Isolation im Krankenhaus aufgrund einer Infektion o. Kolonisation mit MRSA* Hyg. Med. 30. Jg. 2005 - Issue 7/8, S. 234 - 243 *How patients experience isolation in hospital due to MRSA infection or colonisation

c-MRSA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Profile: VRE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

VRE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Profile: ESBL ( Extended-Spectrum Beta-Lactamases ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

MRSA and other multiresistant bacteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

16.09.2011 - MRE - Düsseldorf Development of the rate of 3 rd Generation Cephalosporin resistant E. coli Average ESBL strains make up a growing proportion of E. coli-isolates in German ICUs Month/Year y axis: percent of resistant bacteria

16.09.2011 - MRE - Düsseldorf ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

ESBL Principles ,[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],Management of antibiotic resistant Enterobacteria 16.09.2011 - MRE - Düsseldorf *Dealing with patients with high resistant Enterobacteria including ESBL-producers

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sources of infection for CRE: 16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Risks from CRE: 16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Proposed measures for CRE 16.09.2011 - MRE - Düsseldorf

MBL-producers = Metallo-Beta-Lactamase-producers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

MBL 16.09.2011 - MRE - Düsseldorf Carbapenemase-producers discovered so far The phenomenon of Carbapenem resistance is not new; 4 different resistance mechanisms are currently known Italy Turkey India

MBL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf * Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen (National Reference Centre for the Surveillance of Nosocomial Infections)

ESBL / MBL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Measures for ESBL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

Aspects of hospital hygiene for outbreaks of multiresistant bacteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],Basic hygiene/ Disinfection of hands 16.09.2011 - MRE - Düsseldorf

MRSA ,[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

MRSA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],16.09.2011 - MRE - Düsseldorf

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prospects and limitations of hygiene 16.09.2011 - MRE - Düsseldorf

Louis Pasteur 1895: ,[object Object],16.09.2011 - MRE - Düsseldorf

Multiresistant bacteria

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Multiresistant bacteria