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Elementary Microbiology for IC

Dr. Sushma Krishna, Microbiologist, g
AIMS
Staphylococcus aureus lives where?
Harmlessly on the skin
hands,
axilla axilla,
groins
nose.
d f h b d Can cause disease if it enters the body, via
-cuts, surgical incisions, catheters etc. g
Lets hear the antibiotic story.
1929:Penicillin, 1950 1929:Penicillin, 1950
Treatment: Methicillin/oxacillin (MRSA) 1970
B-lactamases
Treatment: Methicillin/oxacillin (MRSA), 1970
T tm nt: n m in t >1997
Methicillin Resistant Staphylococcus
Aureus(MRSA)
Treatment: vancomycin etc, >1997
Vancomycin Resistant Staphylococcus
?/Nephrotoxic/expensive
Vancomycin Resistant Staphylococcus
aureus (VRSA)
METHICILLIN
RESISTANT RESISTANT
STAPHYLOCOCCUS
AUREUS AUREUS
Infections caused by MRSA Infections caused by MRSA
Nosocomial pneumonia Nosocomial pneumonia
surgical site infection
CRBSI (li l t d) CRBSI (line-related)
UTI
Shunt infections
Wound infections- cellulitis abscess Wound infections cellulitis, abscess,
furuncles, boil, folliculitis
Burn infections Burn infections
Complication- sepsis, endocarditis etc
Transmitted from person to person by
direct contact with the skin clothing or direct contact with the skin, clothing, or
area (for example, sink, bench, bed, and
utensil) that had recent physical contact ) p y
with a MRSA-infected person.
Diagnosed by -culture , PCR/molecular g y ,
methods if outbreak suspected.
MRSA are usually resistant to multiple y p
antibiotics.
Need to have antibiotic susceptibility p y
determined to choose the correct or
appropriate antibiotic therapy.
Skin organisms, Skin organisms,
Contaminated catheter
hub
1
Endogenous Skin flora
Extrinsic HCW hands
Skin
Vein
Fibrin sheath,
thrombus
Hematogenous
from distant infection
Why worry about MRSA?
What can be done?
GET MOTIVATED TO
PREVENT IT
1) Infection control )
Hand-washing before, between,
after patient contact
Improve overall standards of
h ( d )
p
hygiene (ward matron)
Treat MRSA patients in
isolation or cohort
S th MRSA i f Screen the MRSA carriers of
staff, decontaminate them
avoiding skin contact with
i f t d l it infected people or items
they have touched
MRSA prevention contd- MRSA prevention contd
Wear disposable gloves, p g
gowns, and masks when
treating or visiting
hospitalized MRSA p
patients.
Cover skin abrasions and
minor lacerations minor lacerations
immediately
Reduce bacterial
resistance: - resistance:
Stop over-prescription
of antibiotics
Always finish course of Always finish course of
antibiotics
Enterococci story.
Treatment: Penicillin/Ampicillin reatment Pen c ll n/Amp c ll n
Treatment: Vancomycin
B-lactamases
Treatment: Vancomycin
Vancomycin
?
Resistant
Enterococci(VRE)
Where does VRE live in hospital? Where does VRE live in hospital?
Infections caused by VRE Infections caused by VRE
CA- Urinary tract infection CA Urinary tract infection
CRBSI
P th ti l I f ti d diti Prosthetic valve Infective endocarditis
Surgical site infections, Wound
infections
Enterococci live in the gut, although they can cause
infection anywhere in the body infection anywhere in the body.
VRE spreads from person to person
Western data- about 30% of all enterococcal
infections are now caused by vancomycin-resistant
strains (VRE).
They are inherently resistant to several antibiotics They are inherently resistant to several antibiotics
Vancomycin resistance is acquired when a sensitive
Enterococcus acquires a special piece of DNA called a
plasmid The new strain is called vancomycin resistant plasmid. The new strain is called vancomycin-resistant
enterococci (VRE).
VRE appears able to transfer vancomycin resistance
t l t d b t i h MRSA ( thi illi to unrelated bacteria such as MRSA (methicillin-
resistant Staphylococcus aureus).
EMERGENCE OF DRUG
RESISTANCE RESISTANCE
Susceptible bacteria
Resistance
gene
transfer
Resistant bacteria
Newresistant bacteria New resistant bacteria
Lancet Infect Dis , 2001;1(5): 31432
GN Multi Drug Resistant
i (MDR) organsims (MDR)
Gram negative bacteria with
i 2/3 l f d resistance to 2/3 class of drugs are
MDRs MD
(E.coli,Pseudomonas,Klebsiella,etc.)
Most of the hospital strains are MDR.
Who gets gram negatives MDR
i f i ? infection?
Long term antibiotic exposure Long term antibiotic exposure
Prolonged ICU stay
Severe illness-immunocompromised
Residence in an institution with high Residence in an institution with high
rate of 3
rd
generation
h l i cephalosporins use.
Instrumentation / catheterization
Gram negative MDR s
Treatment: Penicillin/Ampicillin
Ceftriaxone/cefuroxime/cefta/ cefa-sulb/pip-tazo etc
Beta lactamases
Ceftriaxone/cefuroxime/cefta/ cefa sulb/pip tazo etc
Imipenem/Meropenem
Extended spectrum beta
lactamases(ESBL)
Imipenem/Meropenem
Carbapenemases, Metalo- beta
colistin/Tigecycline
lactamases(MBL)
?
Transmission Precautions Transmission Precautions
Hand Washing Hand Washing
PPE
Minimum Traffic
Care of equipment & articles
Limit Transport Limit Transport
Handling soiled linen g
Cleaning
PREVENTION PREVENTION
Limit high rate of 3rd generation Limit high rate of 3rd generation
Cephalosporin use
Follow standard precautions F p
Contact, droplet, airborne isolation
precautions p
Cleaning and disinfection of touched surfaces
Provide data and watch the incidence rates r ata an watch th nc nc rat
Share your experience- Increase awareness
among HCW. g
ESBL detection, Gram negative
bacteria
Representation of emerging healthcare-
associated infections over time associated infections over time
Herwaldt LA, Wenzel RP. Dynamics of hospital-acquired infections
Acinetobacter Acinetobacter. ..
ICU nightmare- endemic!
Rapidly emerging pathogen in the health care setting,
Survives under a wide range of environmental
conditions
Lives for extended periods of time on surfaces
Frequent cause of outbreaks of infection
Resistant to all antibiotics (colistin Tigecycline Resistant to all antibiotics (colistin, Tigecycline,
levo)
Diseases caused- VAP
Wound infections Wound infections
Bacteremia, septicemia
Urinary tract infections
Lets understand.
Methods for control and prevention of multidrug-
resistant Acinetobacter infection.
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Eliopoulos G M et al. Clin Infect Dis. 2008;46:1254-1263
What does a microbiology report
f ll h b ? of all these superbugs mean?
Is it named? m
Call ICT, inform
Ask doc colonization or infection?
Colonization needs good nursing, not antibiotics
Follow VAP bundles/CRBSI/all bundles,
protocols
Prevent cross-transmission- follow standard
and isolation precautions and isolation precautions
Clean your environment
Disinfect surfaces & places regularly and Disinfect surfaces & places regularly and
promptly