Week 9 - Topic 3: MDRO - Gram Negative Flashcards
What are the 6 opportunistic gram - enterobacteriacea that are resistant?
1) Escherichia coli
2) Klebsiella
3) Serratia
4) Proteus
5) Citrobacter
6) Enterobacter
What are the 3 pathogenic gram - bacteria that are resistant?
1) Shigella
2) Salmonella
3) Yersinia
What are ESBLS?
Enterobacteriaceae acquired extended spectrum beta-lactamases
They are plasmids that carry beta-lactamases (AmpC) and porin mutation (for altered cell membrane)
What antibiotic (3) does ESBL inactivate?
3rd generation cephalosporin (extended-spectrum)
Aminoglycosides
Monobactams
What do we use to treat ESBL producing Enterobacteriaceae?
Carbapenems
Cephamycins (2nd generation)
True or False: Enterobacteriaceae can be resistant to carbapenems?
True
What are 3 CP (carbapenemase producing) plasmids and when were they found?
2002: Klebsiella pneumonia carbapenemase (KPC)
2004: found on Acinetobacter and Pseudomonas
2007: New Delhi metallo-beta-lactamase (NDM-1)
What are CRE?
Carbapenem resistant enterobacteriaceae:
bacteria of that family resistant to carbapenem regardless of method of resistance
What are CPE?
Carbapenemase producing enterobacteriaceae:
bacteria of that family that produce an enzyme which breaks down carbapenem
What are CPO?
Carbapenemase producing organisms:
bacteria of that family or not (ex: Pseudomonas) that produce an enzyme which breaks down carbapenem
What are the 5 genes which code for CP plasmids in CPOs?
1) KPC - Klebsiella Pneumoniae Carbapenemase
2) NDM - New Delhi Metallo beta-lactamase
3) VIM - Verona Integron-encoded metallo beta-lactamase
4) OXA-48 - Oxacillinase carbapenemase type 48
5) IMP - Imipenemase Metallo beta-lactamase
What classes of antimicrobials are CPOs resistant to?
Broad spectrum penicillins with b-lactamase inhibitors 3rd generation cephalosporin Quinolones Aminoglycosides Carbapenems
What is especially dangerous about CREs?
They are resistant to almost ALL ANTIBIOTICS
they can lead to a potential epidemic
What are the 3 mechanisms of carbapenem resistance?
1) Production of carbapenemase
2) Beta-lactamases (ex: AmpC)
3) Alteration of bacteria’s cell membrane (ex: porin mutation)
2) and 3) may happen together
True or False: MRSA, VRE, CRE, CPE and CPO are only spread from person-to-person.
False, they can also live on drains/sinks.
Why is it not recommended to empty chest tubes and dialysis fluid, to dispose body fluids and to rinse items in sinks designated for hand hygiene?
The MDRO living on those equipment/waste can colonize the sink and infect others/surfaces from backsplash (as far as 1 meter!)
True or False: VRE and MRSA outbreaks must be reported to the QC ministry of health.
True
