Bacterial animation and management

BACTERIAL ANIMATION

AND

MANAGEMENT

2

SAMIR EL ANSARY

ICU PROFESSOR

AIN SHAMS

CAIRO

[email protected]

Global Critical Carehttps://www.facebook.com/groups/1451610115129555/#!/groups/145

1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY

Outline

2

Escherichia coli

Klebsiella

pneumoniae

Pseudomonas

aeruginosa

Acinetobacter

baumannii

Staphylococcus

aureus

Enterococci

Health Care-Associated

Infection (HAI)

* Hospital acquired infection

* Nosocomial infection


Infection (HAI)

3

• Localized or systemic condition resulting from an adverse reaction to

the presence of an infectious agent(s) or its toxin(s)

• There must be no evidence that the infection was present or

incubating at the time of admission to the hospital

• For most bacterial infections, this means that the infection usually

become evident 48 hours (the typical incubation period) or more after

admission


Infection (HAI)

4

Because the incubation period varies with

- the type of pathogen

- the patient’s underlying condition

Each infection must be assessed

individually for evidence that links to

the hospitalization


Infection (HAI)

5

May be caused by infectious agents from

•Endogenous sources :- skin, nose, GI tract or

vagina that are normally inhabited by

microorganisms

•Exogenous sources :- patient care

personnel, visitors, patient care equipment,

medical devices or health care environment

BACTERIA

Acinetobacter baumannii

Pseudomonas aeruginosa

Klebsiella pneumoniae

Staphylococcus aureus (MRSA)

No culture & no growth

NOSOCOMIAL BACTERIA ISOLATED

FROM VAP

VAP : Ventilator associated pneumonia

8

Escherichia coli

(Intestinal flora)

10

Cell Wall of Gram-Negative Bacteria

12

Physiologic Action of LPS from the Gram-Negative Cell Wall

13

Animation :Physiologic Action of LPS

14

Antibacterial drugs % Susceptibility

Trimethoprim-sulfamethoxazole

44

Gentamicin 79

Amikacin 99

Percentage of Susceptible E. coli

Isolated from All Clinical Specimens

15

Antibacterial drugs%

Susceptibility

Trimethoprim-sulfamethoxazole 44

Gentamicin 79

Amikacin 99

Amoxicillin-clavulanic acid 85


15

Clavulanic acid : b-lactamase inhibitor



Gentamicin 79

Amikacin 99


Cefotaxime 96

Ceftazidime 96

Cefepime 98

Imipenem 100

Meropenem 100

Ofloxacin 51


15

Extended-Spectrum b–Lactamase

(ESBL)

•penicillins, cephalosporins

b-lactamase inhibitor :- clavulanic acid

17



Gentamicin 35

Amikacin 95


Cefotaxime 0

Cefoperazone-sulbactam 0

Cefepime 0

Imipenem 100

Meropenem 100

Ofloxacin 18

Percentage of Susceptible E. coli ESBL

producing

16

• Mucoid colony

Klebsiella18

Phagocytosis Blocked by Capsule (Animation)

19

•Enterotoxin)

•Urinary tract infection (UTI)

K. pneumoniae

20

K. pneumoniae

producing ESBL

• Aerobic gram-negative bacilli, non-spore forming

• Grape-like odor

• Saprophyte (soil, water)

• Pyocyanin pigment

• Intestinal flora

Pseudomonas aeruginosa

• Opportunistic pathogen

21

23

Virulence factorsAlginate (slime layers, biofilm)

(polymer of mannuronic & glucuronic acid)

•Prevent phagocytosis

•Adhere to epithelial cells

24

Clinical manifestation of P.

aeruginosa infections

25


Colistin 100

Gentamicin 71

Amikacin 76

Piperacillin-tazobactam 83


Ceftazidime 67

Cefepime 69

Imipenem 69

Meropenem 72

Ciprofloxacin 69

Percentage of Susceptible P. aeruginosa

27

Acinetobacter

• Aerobic gram-negative coccobacilli, non-spore forming

• > 25 species

• A. baumannii is the most common cause of ventilator- associated pneumonia (VAP)

• Opportunistic pathogen

A. baumanniiClinical manifestation of A. baumannii infection

1.Hospital-acquired pneumonia especially VAP

2.Community-acquired pneumonia :The source of infection may be throat carriage, which occurs in 10% of community residents with excessive alcohol consumption

3.Bloodstream infection & endocarditis

4.Skin/soft tissue infection

5.UTI

6.Meningitis

29


Colistin 99

Gentamicin 25

Amikacin 28


Ceftazidime 23

Cefepime 21

Imipenem 26

Meropenem 27

Ciprofloxacin 23

Percentage of Susceptible A. baumannii30

A. baumannii

Persistence in the hospital environment : 3 days to 5 months

1. Resistance to major antimicrobial drugs

2. Resistance to desiccation

3. Resistance to disinfectant

Three factors contributing to the persistence :

31

STAPHYLOCOCCUS

Staphylococcus aureus33

2. Staphylokinase

Staphylokinase

Staphylokinase

Clotting protein

36

3. Hyaluronidase (Spreading factor)

Hyaluronidase digests hyaluronic acid,

the “glue” that holds cells together

37

Clinical manifestation of S. aureus

infection

38



Oxacillin 100

Erythromycin 93

Clindamycin 93

Vancomycin 100

Fosfomycin 88

Percentage of Susceptible S. aureus

(MSSA)

39

40



Oxacillin 0

Erythromycin 1

Clindamycin 2

Vancomycin 100

Fosfomycin 76

Percentage of Susceptible S. aureus

(MRSA)

42

Enterococci

• Gram-positive cocci in chain

44

Enterococci

• Gram-positive cocci in chain

• Commensals of the GI tract of humans & animals

• Diseases :

• Consist of 16 species :- E. faecalis, E. faecium

- Urinary tract infection (UTI)

- Bacteremia, endocarditis

44


Tetracycline 6

Penicillin 9

Ampicillin 10

Vancomycin 99

Levofloxacin 11

Percentage of Susceptible E.

faecium

45

Vancomycin-Resistant

Enterococci VRE

Linezolid (Zyvox®)

46

VRE Transmission

Health care

settings

Community

settings

Colonization of discharged patients

with VRE

Discharge

Colonization of individuals

Colonization of patient

Admission

Colonization & transmission among

food producing animals effects by

Avoparcin / Glycopeptide

Ingestion

Household transmission

Colonization or infection identified

due to selective antimicrobial

pressure and/or underlying illness

Health care transmission Worker hands

Environment

48

BACTERIA Duration of persistance (range)

Acinetobacter spp. 3 days to 5 months

Clostridium difficile (spores) 5 months

Escherichia coli 1.5 hours -16 months

Enterococcus spp.including VRE and VSE 5 days - 4 months

Klebsiella spp. 2 hours to >30 months

Mycobacterium tuberculosis 1 day - 4 months

Pseudomonas aeruginosa 6 hours -16 months;

on dry floor : 5 weeks

Staphylococcus aureus, including MRSA 7 days - 7 months

Persistence of nosocomial bacteria on dry inanimate surfaces

49

Contaminated

inanimate surface Susceptible

patient

Hands of

healthcare worker

Direct transmission

Common Modes of Transmission from

Inanimate Surfaces to Patients

50

Compliance in hand

hygiene:~50%

1. Transduction

2. Conjugation

3. Transformation

Attachment

1 2 3

Phage DNA is

injected into

bacterial cell

Multiplication

Assembly with

some mistake

Generalized Transduction by Lytic Phage (1)

Generalized Transduction (2)

Bacterial cell is broken to release progeny phages

4 5

Phage carrying donor DNA

infects another bacterium (recipient)

53

Generalized Transduction (3)

6 7

Genetic exchangeDonor bacterial DNA is

injected into recipient cell

Any piecies of the DNA of the donor cell can be transferred

3

54

Generalized Transduction

Animation

55

Conjugation by Sex Pilus

56

R Plasmid Conjugation

Animation

57

Transformation : transfer naked DNA

Transformation

Animation

59

GOOD LUCK

SAMIR EL ANSARY

ICU PROFESSOR

AIN SHAMS

CAIRO

[email protected]

Global Critical Carehttps://www.facebook.com/groups/1451610115129555/#!/groups/145

1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY

Date post:	16-Jul-2015
Category:	Health & Medicine
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Bacterial animation and management

Health & Medicine