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Control of MDRO November 2012
Andreas Voss, MD, PhD 1
MRSA
VRE
PNSP
ESBL
CRPSA
MREBC
PRP
CRAB
VRSA
MDRTB
VISA
C-‐MRSA ABRT
CRPSA QREB
MRCNS
ESBL Quinolonen
Aminoglyo-siden
Carba-penem
Cotrim-oxazol
E. coli A B* B* A nvt Klebsiell
a spp A B* B* A nvt
Overige A B* B* A B*
IsolaAe bij resistenAe van: A=enkel B=tenminste twee C=tenminste drie
CAZ Quinol AG Penem PIP Cotrim Acineto-
bacter spp
B B B A nvt nvt
S.malto-philia nvt nvt nvt nvt nvt A
Overige C C C C C nvt
A=single B=at leats two C=at least three
Control of MDRO November 2012
Andreas Voss, MD, PhD 2
ESBL AnAbioAcs
What is the clinical impact of ESBLs?
RetrospecAve Cohort, 198 pt bacteremia: ESBL predictor of mortality (Schwaber, K-‐1587)
RetrospecAve, 177 pt bacteremia: ESBL predictor of mortality BUT NOT INDEPENDENT (Bhavnani, K-‐1588)
Case-‐Control, 72-‐72 pt bacteremia: ESBL predictor of mortality, (Pena, K-‐1585)
ICAAC 2004
¤ Emperical treatment of severe community infecAons (3rd gen. ceph) frequently ineffecAvefail (1)
¤ Inadequate therapy/delay of effecAve treatment is associated with increased mortality (2)
¤ Increased used of carbapenems will lead to increased carbapem resistance (3)
1. Paterson et al. Clin Infect Dis 2004 2. Schwaber et al. J Antimicrob Chemother 2007 3. Schwaber et al. J Antimicrob Chemother 2007
¤ Gloves ¤ Gowns ¤ Masks ¤ Caps ¤ Goggles ¤ Private WC ¤ Single room ¤ CohorAng
¤ Screening ¤ AnAbioAc Stewardship
¤ New strategies ² Are all MDRM the same? ² MRSA vs VRE ² ESBL ESCO vs KLSP
² horizontal vs. verAcal
Control of MDRO November 2012
Andreas Voss, MD, PhD 3
Hands Gloves Gowns Mask Goggles Priv WC Single R Isol. R
MRSA + -‐
VRE + -‐
ESBL-‐coli
+ -‐
ESBL-‐Kleb + -‐
Noro + -‐
XDR-‐Tb + +
¤ PaAents ² On-‐admission
² General versus selected (high-‐risk) ² When other paAent found MDRM+
¤ Room mates ² “unexpected” MDRM-‐pos paAent
¤ HCWs? ² Yes, MRSA ² No, ESBL and VRE
Europe
If you use it – you loose it!
Europe 738.000.000 inhabitants Netherlands 16.000.000 inhabitants
Don’t turn antibiotics into your daily bread
² Are all MDRM the same? ² Different species
Control of MDRO November 2012
Andreas Voss, MD, PhD 4
* plus droplet during respiartory care
Micro-organism Department incl. IC
“outbreak”
Enterobacteriacae Contact * Contact/droplet in single room or cohort
Acinetobacter Strict Strict
S. maltophilia Contact * Contcat/droplet
Overige Nonfermenters incl. PSAE
Contact * Contact/droplet in single room or cohort
² Are all MDRM the same? ² Different species ² Different virulence MRSA vs VRE
² Same measures despite the different virulence? MRSA VRE
² Are all MDRM the same? ² Different species ² Different virulence MRSA vs VRE ² Different?
ESBL E. coli ESBL KLSP
² PrevenAon: verAcal versus horizontal approach
HAI prevenAon
June 25-‐28, 2013 Geneva Switzerland
www.icpic2013.com
Control of MDRO November 2012
Andreas Voss, MD, PhD 5
“We appreciate you reading & ciAng
ARIC and welcome your manuscripts”