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Micro - Important Resistant organisms (i) (other resistant organisms (in…

- - - - 1st recognised in 1961
      - esp in Mediterranean but prevalent worldwide
      - mainly in health facilities but found in community in recent yrs
      - causes same infections as MSSA + numerous healthcare infections...
        
        SSIs
        
        often due to inappropriate wound care/hand hygiene
        
        device-related infections (often involving biofilm)
        
        BSIs
      - gram +ve cocci in clusters, coag +ve, catalase +ve, mannitol fermenter (pink -> yellow colour change)
      - target site modification
        
        by chromosomal MecA gene
        
        low affinity with B-lactams + often erythromycin, gentamicin, ciprofloxacin
      - use glycopeptdes (vancomycin, teicoplanin), linezolid (restricted), daptomycin, tigecycline (not for BSIs)
        
        extra care when prescribing these
        
        therapeutic drug monitoring (renal + oto toxicity)
        
        resistance to vancomycin emerging (VRSA)
        
        linezolid
        
        oral
        
        one rescued on advice from clinical microbiologist + infectious disease specialist
        
        monitoring NB
        
        infection markers + weekly FBC
        
        due to myelosupression - pancytopenia
        
        contraindicated when patient on SSRIs/TCAs due to interactions (unless close observation + BP monitoring possible)
        
        other SEs: peripheral + optic neuropathy, worsening go pre-existing neuropathy, hypertension with tyramine rich food (e.g. cheese, beer, yeast, soya beans), metabolic acidosis
        
        drug licensed for max of 4 yrs
      - prevention
        
        standard precautions (hand hygiene)
        
        stewardship
        
        patient isolation
        
        contact precautions
        
        screening for colonisation + decolonisation (using nasal mupirocin gel or mupirocin bath)
    - - common in Ire, Greece, Cyprus
      - often colonises enteric tract + vagina
        
        not always associated with infection
        
        shed during bowel movement + spread via hands
      - prevalent in community + mostly health facilities
      - causes UTIs, BSIs, long-term device infection, peritonitis, SSIs (NOT DIARRHOEA)
      - gram +ve cocci in short chains
      - grow on MacConkey as small magenta colonies
      - variable haemolytic growth pattens on Columbia blood agar
      - 6 possible resistance mechanisms (depending on genes expressed in the individual isolate)
        
        A: vancomycin + teicoplanin resistance
        
        B: vancomycin resistance + teicoplanin susceptible
        
        AA side chains in cell wall altered
        
        choose antibiotic based on genes
      - risk factor = prior admin of cephalosporins, macrolides, fluroquinolones
    - - 1st recognised in 1970s
      - prevalent in community (esp children)
      - modified PBPs
      - cause CAP, BSIs, meningitis in children + elderly (high mortality in elderly)
      - also resistant to cephalosporins, clarithromycin (a macrolide), tetracylines, co-trimoxazole (Trimethoprim-sulfamethoxazole combo)
      - resistance acquired through acquisition of gene cassette or transposon
      - no vancomycin resistance to date
      - common in spain
      - 90 capsular serotypes
      - 23-valent polysoc vaccine available
        
        recommended for adults + high risk children
        
        effectively prevents both penicillin resistant + susceptible pneumococci