MULTIRESISTENTE GRAMPOSITIVE UND GRAMNEGATIVE ERREGER. Dr. O. Janata FA für Infektionskrankheiten Hygieneteam des DSP Wien

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1 MULTIRESISTENTE GRAMPOSITIVE UND GRAMNEGATIVE ERREGER Dr. O. Janata FA für Infektionskrankheiten Hygieneteam des DSP Wien

2 WARUM SIND ERREGER GEGEN ANTIBIOTIKA RESISTENT?

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6 Meropenem as predictive risk factor for isolation of multidrug-resistant Pseudomonas aeruginosa Journal of Hospital Infection, Volume 83, Issue 2, 2013, Figure 1 Serial changes in the number of patients with multidrug-resistant (MDR) P. aeruginosa isolates (columns) and antimicrobial consumption. Lines: expressed as number of defined daily doses (DDD) per 100 bed-days, total carbapenems;, meropenem, biapenem;, doripenem

7 Meropenem as predictive risk factor for isolation of multidrug-resistant Pseudomonas aeruginosa Journal of Hospital Infection, Volume 83, Issue 2, 2013,

8 Peleg A and Hooper D. N Engl J Med 2010;362:

9 Peleg A and Hooper D. N Engl J Med 2010;362:

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11 Substanz Tage Jahr Trimethoprim-sulfamethoxazole Doxycycline 15 Gentamicin 10 Gentamicin plus ciprofloxacin 14 Amoxicillin-clavulanate 21 Levofloxacin Clarithromycin 20 Ciprofloxacin 14 Gentamicin 14 Trimethoprim-sulfamethoxazole 15 Ciprofloxacin 15 Tobramycin 28 Levofloxacin (14) plus azithromycin plus tobramycin (28) 2003 Clarithromycin 20 Levofloxacin (15) plus gentamicin (30) plus Clarithromycin Tobramycin 28 Levofloxacin 14 Ciprofloxacin Ciprofloxacin 14 Tobramycin (28) plus levofloxacin (14)

12 WELCHE MR-ERREGER SIND WICHTIG?

13 MRE = Multi Resistente Erreger PRSP VREF MRSA ESBL CRE XDR Penicillin resistente Pneumokokken Vancomycin resistente Enterococcen Methicillin resistente Staphylokokken E. coli, K. pneumoniae, P. mirabilis, Carbapenem resistente K. pneumoniae,... Pseudomonas aeruginosa, Acinteobacter baumanii panresistent, omniresistent PDR

14 MRE müssen wir importieren! PRSP VREF MRSA ESBL CRE XDR Penicillin resistente Pneumokokken Vancomycin resistente Enterococcen Methicillin resistente Staphylokokken E. coli, K. pneumoniae, P. mirabilis, Klebsiella pneumoniae,... Pseudomonas aeruginosa, Acinteobacter baumanii panresistent, omniresistent PDR

15 Wave 1 The first pandemic antibiotic-resistant strains, phage type 80/81 - penicillinresistant and produced Panton Valentine leukocidin (PVL) Wave 2 began with the isolation of the first MRSA strain (an archaic clone), which contained staphylococcal chromosome cassette mec I (SCCmecI) Wave 3 new MRSA strains that contained the new SCCmec allotypes, SCCmecII and SCCmecIII The increase in vancomycin use for the treatment of MRSA infections eventually led to the emergence of vancomycin-intermediate S. aureus (VISA) strains Wave 4 a new, smaller, more mobile SCCmec allotype, SCCmecIV (MRSA-IV) with virulence factors, including PVL Vancomycin-resistant S. aureus (VRSA) strains have been isolated exclusively in health care settings

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17 MRSA Anteil an SAU in BK DSP

18 MRSA in vitro Resistenzentwicklung im DSP

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23 WAS HABEN ANTIBIOTIKA MIT MRSA ZU TUN?

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25 Vancomycin resistenter Enterococcus faecium DSP Vancomycin DDD VRE?

26 Vancomycin resistenter Enterococcus faecium DSP Vancomycin DDD VRE

27 Vancomycin resistenter Enterococcus faecium DSP

28 WOVOR SOLLTEN WIR UNS FÜRCHTEN?

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30 MRE Epidemiologie DSP

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32 Escherichia coli with CTX-M Type ESBL and Yellow-Legged Gulls in the South of France This suggests that dense bird colonies, such as the Yellow-legged Gulls in our study, might serve as melting pots for creation of new E. coli variants carrying antibiotic resistance

33 resistente Erreger sind nur für kranke Menschen...

34 Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors Ase Östholm-Balkhed, J Antimicrob Chemother 2013

35 Resistance and fitness of constructed strains. Marcusson LL, Hughes D (2009) Interplay in the Selection of Fluoroquinolone Resistance and Bacterial Fitness

36 Multiresistente Erreger Erreger Invasivität Sterblichkeit AB Resistent pyämische Abszesse Endokarditis S. aureus MRSA CA vs. HA + + CA vs. HA? VRE ESBL E. coli HWI MRE Klebsiellen ? MR Acinetobacter

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41 ?! was kann da Hygiene bewirken

42 DANKE FÜR DIE AUFMERKSAMKEIT