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Enterobacterales (ii) (CPE (enterobacterales which have become resistant…
Enterobacterales (ii)
CPE
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produce enzymes called carbapenamases e.g. IMP, KPC, OXA 48 (main one in Ire), NDM, WIM
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evidence shows it is widespread in hospital environment (sinks, showers)
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UTIs, intra-abdo infections
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Proteus Miribalis
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characteristic appearance on agar - swarming, spreads out + takes over plate
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may cause
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BSI (rare, often a/w urosepsis)
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strongly a/w renal stones (calculi), as bacterium alkalises urine (do renal US)
E Coli gastroenteritis
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VTEC (verotoxigenic)
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bloody diarrhoea , abdo pain
tx: supportive, rehydration
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Klebsiella spp
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normal GI flora, may be pathogenic @ other sites
may cause
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intra-abdo infections (appendicitis, cholecystitis, ascending cholangitis)
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pneumonia
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some strains = hypervirulent, a/w severe necrotising pneumonia/lung abscesses
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ESBL
enzymes carried by enterbacterales (e.g. E Coli, Klebsiella) which make them resistant to 1st-4th gen cephalosporins, sometimes co-amox (augmentin) + pip-taz (tazocin)
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cause UTIs, intra-abdo infections
high prevalence of ESBL producers among nursing home patients in Ire, + in S Europe (prevalence ever increasing)
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Enterobacter spp, Serratia spp, Citrobacter spp
may form part of normal intestinal flora, but typically found in environment
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Plasmids
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highly transmissable, even between species
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