Week 9 - Topic 3: MDRO - Gram Negative

Question 1

What are the 6 opportunistic gram - enterobacteriacea that are resistant?

Answer 1

1) Escherichia coli
2) Klebsiella
3) Serratia
4) Proteus
5) Citrobacter
6) Enterobacter

Question 2

What are the 3 pathogenic gram - bacteria that are resistant?

Answer 2

1) Shigella
2) Salmonella
3) Yersinia

Question 3

What are ESBLS?

Answer 3

Enterobacteriaceae acquired extended spectrum beta-lactamases

They are plasmids that carry beta-lactamases (AmpC) and porin mutation (for altered cell membrane)

Question 4

What antibiotic (3) does ESBL inactivate?

Answer 4

3rd generation cephalosporin (extended-spectrum)
Aminoglycosides
Monobactams

Question 5

What do we use to treat ESBL producing Enterobacteriaceae?

Answer 5

Carbapenems

Cephamycins (2nd generation)

Question 6

True or False: Enterobacteriaceae can be resistant to carbapenems?

Answer 6

True

Question 7

What are 3 CP (carbapenemase producing) plasmids and when were they found?

Answer 7

2002: Klebsiella pneumonia carbapenemase (KPC)
2004: found on Acinetobacter and Pseudomonas
2007: New Delhi metallo-beta-lactamase (NDM-1)

Question 8

What are CRE?

Answer 8

Carbapenem resistant enterobacteriaceae:

bacteria of that family resistant to carbapenem regardless of method of resistance

Question 9

What are CPE?

Answer 9

Carbapenemase producing enterobacteriaceae:

bacteria of that family that produce an enzyme which breaks down carbapenem

Question 10

What are CPO?

Answer 10

Carbapenemase producing organisms:

bacteria of that family or not (ex: Pseudomonas) that produce an enzyme which breaks down carbapenem

Question 11

What are the 5 genes which code for CP plasmids in CPOs?

Answer 11

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

Question 12

What classes of antimicrobials are CPOs resistant to?

Answer 12

Broad spectrum penicillins with b-lactamase inhibitors
3rd generation cephalosporin
Quinolones
Aminoglycosides
Carbapenems

Question 13

What is especially dangerous about CREs?

Answer 13

They are resistant to almost ALL ANTIBIOTICS

they can lead to a potential epidemic

Question 14

What are the 3 mechanisms of carbapenem resistance?

Answer 14

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

Question 15

True or False: MRSA, VRE, CRE, CPE and CPO are only spread from person-to-person.

Answer 15

False, they can also live on drains/sinks.

Question 16

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?

Answer 16

The MDRO living on those equipment/waste can colonize the sink and infect others/surfaces from backsplash (as far as 1 meter!)

Question 17

True or False: VRE and MRSA outbreaks must be reported to the QC ministry of health.

Answer 17

True