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HEALTH CARE

ASSOCIATED INFECTIONS
CREATING DRUG RESISTANCE
ATLAS
(INCORPORATING CDC GUIDELINES)

Dr.T.V.Rao MD

3/22/16

Dr.T.V.Rao MD

Healthcare-associated infections
Healthcare-

associated
infections (HAIs)
are a major, yet
often preventable,
threat to patient
safety
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Dr.T.V.Rao MD

A question to Many

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Dr.T.V.Rao MD

Hospital Breed Many Infections


How good we are to detect makes
difference?

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Dr.T.V.Rao MD

The Hospitals and Microbiology Departments


should create documentation on

central line-associated bloodstream infections


(CLABSI),

catheter-associated urinary tract infections


(CAUTI),

surgical site infections (SSI),

hospital-onset Clostridium difficile infections


(C difficile), and

hospital-onset methicillin-resistant
Staphylococcus aureus
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Dr.T.V.Rao MD

The report includes data reported to


Hospital Infection control committee from
the following
CLABSI: intensive care
units, neonatal intensive
locations:
care unit,

and

wards

CAUTI: intensive care units and wards

C difficile: all inpatient locations in the facility,


with the

exception

well-baby

of the neonatal intensive care units and

locations

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Dr.T.V.Rao MD

MRSA bacteremia: all inpatient locations in the

Microbiology Departments
should Document on
pathogens
The Antibiotic
documentation
includes resistance
data for 31 bugdrug profiles (or
phenotypes,
pathogen-antibiotic
combinations that
3/22/16

Dr.T.V.Rao MD

These phenotypes include:


Methicillin-resistant

Staphylococcus aureus
(MRSA)
Carbapenem-resistant

Enterobacteriaceae
(CRE)
Multidrug-resistant

Pseudomonas
aeruginosa
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Dr.T.V.Rao MD

HOSPITALS CAN
CREATE ANTIBIOTIC
RESISTANCE ATLAS

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Dr.T.V.Rao MD

Why we Need to Create an Atlas

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10

Staphylococcus aureus
S.aureus

cause a range of illnesses, from skin and


wound infections to pneumonia and bloodstream
infections that can cause sepsis and death.

Staph bacteria, including those resistant to first line


therapy, methicillin-resistant S. aureus(MRSA),

are the second most common causes of


healthcare-associated infections according to a
2011 national prevalence survey performed by CDC
(http://www.cdc.gov/HAI/surveillance/index.html).

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Dr.T.V.Rao MD
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Less
severe infections are
common and occur outside

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Dr.T.V.Rao MD

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Phenotype Analytical Definitions


Methicillin-Resistant Staphylococcus aureus (%R)

Analytical

Definition:
Staphylococcus
aureus that has
tested resistant
(R) to at least 1
of the following:
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Dr.T.V.Rao MD

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MRSA with Communityassociated Resistance Pattern


(%R)
Any

MRSA that has tested


resistant (R) to erythromycin
and sensitive (S) to
trimethoprimsulfamethoxazole and has at
least one of the following
additional properties:

1.

Tested Sensitive (S) to both


ciprofloxacin and levofloxacin

2.

Tested Sensitive (S) to


clindamycin

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Dr.T.V.Rao MD

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Documents to Create Atlas


Linezolid-Resistant
MRSA

MRSA (%R)

that has tested resistant (R) to linezolid

Fluoroquinolone-Resistant

MRSA (%R)

MRSA

that has tested resistant (R) to ciprofloxacin and/or


levofloxacin

Vancomycin-Intermediate
MRSA

that has tested intermediate (I) to vancomycin

Daptomycin-Resistant
MRSA

MRSA (%I)

MRSA (Resistant or Intermediate) (%R*)

that has tested non-susceptible (NS) to daptomycin

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Dr.T.V.Rao MD

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Acinetobacter spp
Pathogen

Overview

Acinetobacter is a type of gram-negative


bacteria that is a cause of pneumonia or
bloodstream infections among critically ill
patients.

Fewer than 1 of 10 healthcare-associated


infections are caused by Acinetobacter;
however, according to a 2011 national
prevalence survey performed by CDC, many of
these bacteria have become very resistant to
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Dr.T.V.Rao MD
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antibiotics. Some strains are resistant to

Carbapenem-

Phenotype

Resistant
Analytical
Definitions
Acinetobacter spp.
(%R*)
Any

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Acinetobacter
spp. that has
tested either
intermediate (I) or
resistant (R) to at
least one of the
following:
imipenem,

Dr.T.V.Rao MD

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MDR Acinetobacter spp. (%R)


Any

Acinetobacter spp. that has tested either intermediate (I) or


resistant(R) to at least one drug in at least 3 of the following
6categories:

1.

Extended-spectrum cephalosporins (cefepime, ceftazidime,


cefotaxime, ceftriaxone)

2.

Fluoroquinolones (ciprofloxacin, levofloxacin)

3.

Aminoglycosides (amikacin, gentamicin, tobramycin)

4.

Carbapenems (imipenem, Meropenem, doripenem)

5.

Piperacillin Group (piperacillin, piperacillin/tazobactam)

6.

Ampicillin/sulbactam
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Dr.T.V.Rao MD

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E.coli

Pathogen

Overview

E.coli cause pneumonia, urinary tract infections,


and bloodstream infections in hospitalized
patients.

E. coli bacteria are the fourth most common


cause of healthcare-associated infections
according to a 2011 national prevalence survey
performed by CDC.

Carbapenem-Resistant E.coli is a subset of the


nightmare bacteria carbapenem-resistance
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Dr.T.V.Rao MD
Enterobacteriaceae
(CRE).

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Phenotype Analytical
Definitions
Carbapenem-Resistant

E.coli (%R)

Any

E.coli that has tested resistant (R) to at least one of the


following: imipenem, meropenem, doripenem, ertapenem

Extended-Spectrum

Cephalosporin-Resistant E.coli (%R)

Any

E.coli that has tested resistant (R) to at least one of the


following: ceftriaxone, ceftazidime, cefepime, and cefotaxime

Fluoroquinolone-Resistant

E.coli (%R)

Any

E.coli that has tested resistant (R) to at least one of the


following: ciprofloxacin, levofloxacin, and moxifloxacin
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Any

MDR E.coli (%R)

E.coli that has tested either intermediate


(I) or resistant (R) to at least one drug in at
least 3 of the following 5 categories:

1.

Extended-spectrum cephalosporins
(cefepime, cefotaxime, ceftazidime,
ceftriaxone)

2.

Fluoroquinolones (ciprofloxacin, levofloxacin,


moxifloxacin)

3.

Aminoglycosides (amikacin, gentamicin,


tobramycin)
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Enterobacter spp.
Pathogen

Overview

Enterobacter spp. bacteria cause pneumonia, urinary tract


infections, and bloodstream infections in hospitalized
patients.

Fewer than 1 of 10 healthcare-associated infections are


caused by Enterobacter spp; however, according to a 2011
national

prevalence

survey performed by CDC, many of these bacteria


have become very resistant to antibiotics. Some strains
areresistant to nearly all or all antibiotics.

Carbapenem-Resistant Enterobacter is a subset of the


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Dr.T.V.Rao MD
nightmare
bacteria carbapenem-resistance
Enterobacteriaceae (CRE).

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Phenotype Analytical
Definitions
Carbapenem-Resistant

(%R)

Enterobacter spp.

Any

Enterobacter spp. that has tested


resistant (R) to at least 1 of the following:
imipenem, meropenem, doripenem,
ertapenem

Extended-Spectrum

CephalosporinResistant Enterobacter spp. (%R)

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Any
Enterobacter

spp. that has tested


Dr.T.V.Rao MD

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MDR Enterobacter spp. (%R)


Any

Enterobacter spp. that has tested either intermediate (I)


or resistant (R) to at least one drug in at least 3 of the
following 5categories:

1.

Extended-spectrum cephalosporins (cefepime, cefotaxime,


ceftazidime, ceftriaxone)

2.

Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)

3.

Aminoglycosides (amikacin, gentamicin, tobramycin)

4.

Carbapenems (imipenem, meropenem, doripenem,


ertapenem)

5.

Piperacillin Group (piperacillin, piperacillin/tazobactam)


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Klebsiella spp.
Pathogen

Overview

Klebsiella spp. bacteria cause pneumonia, urinary


tract infections, and bloodstream infections in
hospitalized patients, as well as patients in nursing
homes and other healthcare facilities.

Klebsiella spp. bacteria are the third most


common cause of healthcare-associated infections
according to a 2011 national prevalence survey
performed by CDC. Klebsiella spp. are becoming
more resistant to even antibiotics of last resort,
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Dr.T.V.Rao MD
such as carbapenems.

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Any

Phenotype Analytical Definitions


Carbapenem-Resistant Klebsiella
spp. (%R)

Klebsiella oxytoca or Klebsiella


pneumoniae that has tested
resistant (R) to at least 1 of the
following: imipenem,
meropenem,doripenem, ertapenem

Extended-Spectrum

CephalosporinResistant Klebsiella spp. (%R)

Any

Klebsiella oxytoca or Klebsiella


pneumoniae that has tested
resistant (R) to at least one of the
following: ceftriaxone, ceftazidime,
cefepime, cefotaxime
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Dr.T.V.Rao MD

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MDR Klebsiella spp. (%R)


Any

Klebsiella oxytoca or Klebsiella pneumoniae that has


tested either intermediate (I) or resistant (R) to at least one
drug in at least 3 ofthe following 5 categories:

1.

Extended-spectrum cephalosporins (cefepime, cefotaxime,


ceftazidime, ceftriaxone)

2.

Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)

3.

Aminoglycosides (amikacin, gentamicin, tobramycin)

4.

Carbapenems (imipenem, meropenem, doripenem,


ertapenem)

5.

Piperacillin Group (piperacillin, piperacillin/tazobactam)


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Pseudomonas aeruginosa
Pathogen

Overview

Pseudomonas aeruginosa is a common cause of healthcareassociated infections including pneumonia, bloodstream


infections,urinary tract infections, and surgical site infections.

Pseudomonas

aeruginosa bacteria are the third most common


cause of healthcare-associated infections according to a
2011national prevalence survey performed by CDC. P.
aeruginosa are becoming more resistant to even antibiotics of
last resort, such as carbapenems.

Find more information about multidrug-resistant


Pseudomonas aeruginosa in the AR Threat Report
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Phenotype Analytical
Definitions

Carbapenem-Resistant

Pseudomonas aeruginosa
(Resistant or Intermediate) (%R*)

Any

Pseudomonas aeruginosa that has tested


either intermediate (I) or resistant (R) to at least
1 of the following: imipenem,meropenem, or
doripenem

Extended-Spectrum

Cephalosporin-Resistant
Pseudomonas aeruginosa (%R)

Any

Pseudomonas aeruginosa that has tested


resistant
(R) to at least one
3/22/16
Dr.T.V.Raoof
MD the following:
cefepime and ceftazidime

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Any

MDR Pseudomonas
aeruginosa (%R)

Pseudomonas aeruginosa that has tested


either intermediate (I) or resistant (R) to at least 1
drug in at least 3 of the following 5categories:

1.

Extended-spectrum cephalosporins (cefepime,


ceftazidime)

2.

Fluoroquinolones (ciprofloxacin, levofloxacin)

3.

Aminoglycosides (amikacin, gentamicin,


tobramycin)

4.

Carbapenems (imipenem, meropenem,


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Dr.T.V.Rao MD
doripenem)

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Other resistant patterns of


Pseudomonas
Fluoroquinolone-Resistant

Pseudomonas aeruginosa (%R)

Any

Pseudomonas aeruginosa that has tested resistant (R) to at


least one of the following: ciprofloxacin, levofloxacin

Aminoglycoside-Resistant

Pseudomonas aeruginosa (%R)

Any

Pseudomonas aeruginosa that has tested resistant (R) to at


least one of the following: amikacin, gentamicin, tobramycin

Pip/Tazobactum-Resistant

Pseudomonas aeruginosa (%R)

Any

Pseudomonas aeruginosa that has tested resistant (R) to at


least one of the following: piperacillin, piperacillin/tazobactam
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Enterococcus faecium

Pathogen Overview

Enterococci cause a range of illnesses, mostly among patients receiving


healthcare, but include bloodstream infections, surgical site infections, and
urinary tract infections.

Overall, Enterococcus spp. are the fifth most common cause of healthcareassociated infections according to a 2011 national prevalence survey performed
by CDC.

The proportion of infections that occur with a vancomycin-resistant strain


differs by the two most common species of

Enterococcus.

Find more information on Vancomycin-resistant Enterococcus faecium in the


AR Threat Report.
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Dr.T.V.Rao MD

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Phenotype Analytical Definitions


Vancomycin-Resistant

Enterococcus faecium (%R)


Any

Enterococcus faecium
that has tested resistant
(R) to vancomycin

Daptomycin-Resistant

Enterococcus faecium
(%R*)
Any

Enterococcus
faecium
3/22/16
that has tested non-

Dr.T.V.Rao MD

33

Enterococcus faecalis

Pathogen Overview

Enterococci cause a range of illnesses, mostly among patients


receiving healthcare, but include bloodstream infections, surgicalsite
infections, and urinary tract infections.

The proportion of infections that occur with a vancomycin resistant


strain differs by the two most common species ofEnterococcus.

Overall, Enterococcus spp. are the fifth most common cause of


healthcare-associated infections according to a 2011
nationalprevalence survey performed by CDC.

Find more information on Vancomycin-resistant Enterococcus


faecalisin the AR Threat Report
3/22/16

Dr.T.V.Rao MD

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Phenotype Analytical
Definitions
Vancomycin-Resistant

Enterococcus faecalis (%R)


Enterococcus

faecalis that
has tested resistant (R) to
vancomycin

Daptomycin-Resistant

Enterococcus faecalis (%R*)


Enterococcus

faecalis that
has tested non-susceptible
(NS) to daptomycin

3/22/16

Dr.T.V.Rao MD

35

Coagulase-Negative
Staphylococci
Pathogen

Overview

Coagulase-negative

staphylococci
infections cause bloodstream
infections and infections of
prosthetic material. Overall, these
bacteria, commonly found on the
skin, are associated with only
about 1 out of every 10 healthcareassociated infections according to
a 2011 national prevalence survey
performed by CDC.
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Dr.T.V.Rao MD

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Understanding Coagulase
Negative Staphylococcus

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Dr.T.V.Rao MD

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Phenotype Analytical
Vancomycin-Resistant
Coagulase-Negative
Definitions
Staphylococci (Resistant or

Intermediate) (%R*)

Coagulase-Negative

Staphylococci that has


tested resistant(R) or
intermediate(I) to
vancomycin
Vancomycin-Resistant

Coagulase-Negative
Staphylococci (%R)
Coagulase-Negative
3/22/16

Staphylococci that has


tested resistant(R) to

Dr.T.V.Rao MD

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Enterobacteriaceae spp.
Pathogen

Overview

The three most common types of


Enterobacteriaceae causing healthcare acquired
infections include Enterobacter spp.,Klebsiella
spp., and E.coli.

These bacteria cause pneumonia, urinary tract


infections, and bloodstream infections in patients.

Emerging resistance to carbapenems makes


treating these resistant infections very difficult.

Find more information on carbapenem-resistant


3/22/16
Enterobacteriaceae
in theDr.T.V.Rao
AR MD
Threat Report.

39

Phenotype Analytical
Definitions
Any

E.coli,
Klebsiella oxytoca,
Klebsiella
pneumoniae, or
any Enterobacter
spp. that has
tested resistant
(R) to at least one
of the following:

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In spite of Many Developments Hand


Washing still continues to be great
boon to stop spread of Hospital
Associated Infections

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Hand Washing Saves Many


Lives
Are we Practising

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FOR MORE INFORMATION ABOUT THE


AR ATLAS, VISIT:
HTTP://WWW.CDC.GOV/HAI/SURVEILL
ANCE

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Dr.T.V.Rao MD

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Attention of Viewers

I am thankful to many in the world who made me to achieve my desired goals faster than I
thought, having > 3-5 million health professionals share and utilize my knowledge for the
benefit of mankind, Today I wish to be freelancer to the world to create interest in Medical,
Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases and Hospital
associated Infection wish to be your partner in educating many millions who know well the
importance of Infectious diseases

You

can visit many web sites of mine

www.medmicrobes.com
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a friend on Facebook with tummalapalli venkateswararao access

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Microbiology

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Infection care

Microbiology
For

connected Travancore Medical College

any assistance on INFECTION REALTED ISSUES CONTACT ME AT doctortvrao@gmail.com

Mob
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7204113154

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45

Program

Created by Dr.T.V.Rao MD for


Benefit of Medical and Paramedical
Professionals in the Developing World
Created from World Wide Resources
Email
doctortvrao@gmail.com
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Dr.T.V.Rao MD

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