Transcript Copyright © Texas Education Agency, 2014.

Nosocomial Antibiotic Resistant
Organisms
Copyright © Texas Education Agency, 2014. All rights reserved.
.
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Copyright © Texas Education Agency,
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2014. All rights reserved.
How Antibiotic Resistance Happens
• There are many bacteria and a few of them are
drug resistant, naturally.
• Patient is given antibiotics that kill the infecting
bacteria that is not resistant as well as the ‘good’
bacteria in the gut that help protect the body
from infection.
• The drug resistant bacteria are now allowed to
grow and take over.
• Some of the drug resistant bacteria share their
resistance with other bacteria causing more
problems.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Examples of How Antibiotic Resistance
Spreads
• Animals get antibiotics and develop resistant organisms in
their gut. Humans get prescribed antibiotics and develop
resistant organisms in their gut.
• Drug resistant bacteria from animals can spread to crops
through using manure as fertilizer or when cuts of meat are
not cooked or handled properly.
• Humans can spread resistant bacteria in the community
they are in or get treatment in a health care facility like a
nursing home or hospital and spread the resistant
organisms there.
• Once in a health care facility resistant organisms are spread
through fomites or inanimate objects or by health care
workers going between patients.
Copyright © Texas Education Agency,
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2014. All rights reserved.
• Methicillin-resistant Staphylococcus aureus
(MRSA) is becoming more prevalent in healthcare
settings. MRSA is a type of staph bacteria that is
resistant to certain antibiotics called betalactams. These antibiotics include methicillin and
other more common antibiotics such as oxacillin,
penicillin, and amoxicillin. According to CDC data,
the proportion of infections that are antimicrobial
resistant has been growing. In 1974, MRSA
infections accounted for two percent of the total
number of staph infections; in 1995 it was 22%; in
2004 it was 63%.
Copyright © Texas Education Agency,
.
2014. All rights reserved.
MRSA - Methicillin resistant
Staphylococcus aureus
• Resistant to most antibiotics
• Found in health care facilities
– hospitals
– long term care facilities
– other care facilities
• Not a threat to a healthy individual
Copyright © Texas Education Agency,
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2014. All rights reserved.
MRSA Concerns
• MRSA is difficult to contain
• MRSA is easily spread
Copyright © Texas Education Agency,
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2014. All rights reserved.
MRSA Risk Factors
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Surgery
Devices used in invasive procedures
Burn wards or intensive care units (ICU)
Age
Treatment with multiple antibiotics
Severe illness or disability
Prolonged or repeated hospital stays
Compromised immune system
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2014. All rights reserved.
MRSA Transmission
• Direct contact between health-care workers and
clients.
• Health-care workers are the main carriers of
MRSA
• Colonization vs. Infection
– Colonization means that the organism is present or in
the body, but is not causing illness.
– Infection means that the organism is present and
causing illness.
• MRSA is not usually spread through the air
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2014. All rights reserved.
Identifying MRSA infection
• Symptoms
– Drainage from a wound
– Fever and chills
– Elevated white blood count
• Common sites of infection
–
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Respiratory tract
Surgical wounds
Perineum or rectum
Skin
Urinary tract
Copyright © Texas Education Agency,
.
2014. All rights reserved.
MRSA Prevention
• Proper hand-washing
– Before caring for each patient
– After removing gloves
– Before leaving the patient’s room
• Follow facility protocol for standard
precautions
Copyright © Texas Education Agency,
.
2014. All rights reserved.
Community Acquired MRSA
• MRSA infections that are acquired by persons
who have not been recently (within the past
year) hospitalized or had a medical procedure
(such as dialysis, surgery, catheters) are known
as CA-MRSA infections.
• Staph or MRSA infections in the community
are usually manifested as skin infections, such
as pimples and boils, and occur in otherwise
healthy people.
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2014. All rights reserved.
• Vancomycin resistant enterococcus (VRE) – The
majority of VRE infections occur in the hospital
setting. Enterococci are bacteria that are
normally present in the human intestines and in
the female genital tract and are found in the
environment. Vancomycin is an antibiotic used to
treat infections caused by enterococci. In some
instances, enterococci have become resistant to
this drug and thus are called vancomycinresistant enterococci (VRE).
Copyright © Texas Education Agency,
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2014. All rights reserved.
VRE Concerns
• VRE is hard to treat
• VRE can pass on their drug-resistant genes
Copyright © Texas Education Agency,
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2014. All rights reserved.
VRE Risk Factors
•
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Severe illness
Treatment with multiple antibiotics
Abdominal or cardiac surgery
Devices used in invasive procedures
Age
Intensive care unit (ICU)
Prolonged or repeated hospital stays
Compromised immune system
Copyright © Texas Education Agency,
.
2014. All rights reserved.
Pathogenesis of VRE
• Opportunistic
• Bacteria transmitted between clients and
health-care workers
Colonized vs. infected persons
Copyright © Texas Education Agency,
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2014. All rights reserved.
Signs of Infection
• Drainage from a wound
• Fever and chills
• Elevated white blood count
Copyright © Texas Education Agency,
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2014. All rights reserved.
Role of health care workers in
prevention of VRE
• Hand-washing helps stop the spread of VRE
– Wash before caring for a patient
– After removing gloves
– Before leaving the patient’s room
• Follow facility protocol for standard
precautions
Copyright © Texas Education Agency,
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2014. All rights reserved.
• Gram-negative bacteria are those bacteria
that do not retain crystal violet dye in the
Gram staining protocol.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Gram-negative Infections
• Include those caused by Klebsiella, Acinetobacter,
Pseudomonas aeruginosa, and E. coli, as well as many other
less common bacteria..
– Klebsiella bacteria are normally found in the human intestines
and in human stool. Patients whose care requires devices like
ventilators or intravenous catheters, and those taking long
courses of certain antibiotics are most at risk for Klebsiella
infections.
– Acinetobacter is a group of bacteria commonly found in soil and
water. Acinetobacter can also be found on the skin of healthy
people, especially healthcare personnel.
– Serious Pseudomonas infections usually occur in people in the
hospital, especially those with weakened immune systems,
those on breathing machines, those with devices such as
catheters, and those with wounds from surgery or burns.
Copyright © Texas Education Agency,
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2014. All rights reserved.
Gram-negative Infections
– Cause infections including pneumonia,
bloodstream infections, wound or surgical site
infections, and meningitis in healthcare settings
– One of the several unique characteristics of Gramnegative bacteria is the structure of the outer
membrane. This outer membrane protects the
bacteria from several antibiotics, dyes, and
detergents which would normally damage the
inner membrane or cell wall.
Copyright © Texas Education Agency,
.
2014. All rights reserved.