SlideShare une entreprise Scribd logo
1  sur  35
Télécharger pour lire hors ligne
Healthcare Associated Infections and ESKAPE
Pathogens
2
Human microbiome
Healthcare Associated Infections (nosocomial) are infections that are
acquired as a result of healthcare interventions. There are a number of
factors that can increase the risk of acquiring an infection, but high
standards of infection control practice minimise the risk of occurrence.
A pathogen is a micro-organism that has the potential to cause disease.
An infection is the invasion and multiplication of pathogenic microbes
in an individual or population. Disease is when the infection causes
damage to the individual’s vital functions or systems.
Definition
3
4
Infections pattern
5
Nosocomial infections - Infections that are acquired in
hospital (>48 hours after admission). They may occur even
after discharge. Approx 9% of patients affected – risk
increases with length of stay. Significant financial burden on
NHS
Nosocomial infections are often caused by opportunistic
pathogens, i.e. those which do not normally cause
infections in healthy people
Hospital microorganisms tend to be generally more
resistant to antbiotics and are therefore much harder to
treat
Hospital micro-organisms
Organisms in Healthcare Settings and known
nosocomial infections:
6
Acinetobacter baumannii
Burkholderia cepacia
Candida albicans
Clostridium difficile
Clostridium sordellii
Enterobacteriaceae (carbapenem-
resistance)
Gastroenteritis
Hepatitis
Pneumonia (Ventilator-associated)
HIV
Influenza
Klebsiella
Legionnaires' disease
Mycobacterium abscessus
Norovirus
Pseudomonas aeruginosa
Staphylococcus aureus (coag-)
Stenotrophomonas maltophilia
Tuberculosis (TB)
Urinary tract infection
Enterococci
Extended Spectrum Beta-lactamase
producing organisms (ESBL+)
Vancomycin Resistant Staphylococcus
aureus (VRSA)
Vancomycin Resistant Enterococci (VRE)
pneumonia
Methicillin Resistant Staphylococcus
aureus (MRSA)
Acinetobacter spp
7
Bloodstream infection (BSI)
Hospital-acquired pneumonia (HAP)
Surgical site infection (SSI)
Urinary tract infection (UTI)
Hospital-acquired diarrhoea
Most common nosocomial infections
Mortality
8
35% Staphylococci (coagulase-negative)
25% Staphylococcus aureus
11.2% Enterococci
9.7% Fungi
6.2% Enterobacter spp
4.9% Pseudomonas spp
Bloodstream infections (BSI)
Common pathogens
9
Peripheral intravenous line
and Central venous catheter
(CVC)
43% of all BSI are central line
(CVC) related!
10
Ventilator-associated pneumonia
Normal chest x-ray Ventilator-associated pneumonia
11
Pneumonia - Infections of the respiratory tract
Ventilator
12
Risk factors old age,
antibiotic therapy,
immunosuppression,
chemotherapy and
others
Diarrhoea
Clostridium difficile
13
20% Staphylococcus aureus
16% Pseudomonas spp
15% Staphylococci (coagulase-negative)
<10% Enterococcus spp
<10% Escherichia coli
<10% Enterobacter spp
<10% Fungi
Surgical site infections
Virulence
Bacterial dose
Impaired
host resistance
Pathogenesis
14
50% Gram-negative coliforms
25% Fungi
10% Enterococci
Urinary Tract Infections (UTI)
Common pathogens
15
Transmission of microorganisms
Contact – most common
• Direct (physical contact)
• Indirect (via contaminated objects)
Airborne Transmission
• Respiratory droplets
• Inhalation of infectious particles
Blood-borne transmission
Food-borne
ESKAPE Pathogens
Bacterial species from the ESKAPE group (i.e. E.faecium , Staphylococcus
aureus , Klebsiella pneumoniae , Acinetobacter baumannii ,
Pseudomonas aeruginosa and Enterobacter species) are frequently
resistant to antibiotics. "In many respects it’s far worse than MRSA,"
Antimicrobial resistance among both Gram-positive and Gram-negative
bacteria has been on the rise in the past few years. The presence of
multidrug-resistant (MDR) pathogens has become a cause for serious
concern with regard to nosocomial infections. The most common and
threatening MDR pathogens have been grouped together under the
acronym ‘ESKAPE,’ which stands for E.faecium, Staphylococcus aureus,
Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa
and Enterobacter spp.
16
17
Risk Factors Patient risk factors
Environmental risk factors
Hospital micro-organisms
Antibiotics
Operative risk factors
18
Patient risk factors
• Very old or very young
• Immunocompromised (HIV+, cancer,
chemotherapy, diabetes, alcoholism)
• Surgery
• Impaired local blood supply (peripheral vascular
disease)
• Medical devices (urinary catheters, intravascular
catheters, prosthetic joints or heart valves, endotracheal
tubes etc)
• Pre- and Pos-toperative issues
• Malnutrition
19
• Contaminated air-conditioning systems (Ventilation )
• Contaminated water systems
• Staffing and physical layout of the facility (eg, nurse-
to-patient ratio, open beds close together)
• Operating room environment
• Surgical attire and drapes
• Asepsis and surgical technique
• Conventional sterilization of surgical instruments
Environmental risk factors
Multiple drug resistance (MDR)
Multiresistance is a condition enabling disease-causing
microrganisms (bacteria, viruses, fungi or parasites) to
resist distinct antimicrobials, first and
foremost antibiotics,but also antifungal drugs, antiviral
medications, antiparasitic drugs, chemicals of a wide
variety[1] of structure and function targeted at eradicating
the organism.
20
Bacterial resistance
Various microorganisms
have
survived for thousands of
years
by their ability to adapt
to antimicrobial agents. They
do so via spontaneous
mutation or by DNA transfer.
This process enables some
bacteria to oppose the
action of
certain antibiotics, rendering
the antibiotics ineffective.
21
 No longer relying on a
glycoprotein cell wall
 Enzymatic deactivation of
antibiotics
 Decreased cell wall permeability
to antibiotics
 Altered target sites of antibiotic
 Moving of toxic substances
and antibiotics out of the cell[5]
 Increased mutation rate as a
stress response[6]
Several mechanisms in attaining
multi-drug resistance:
22
Some resistant bacteria are able to
transfer copies of DNA that code
for a mechanism of resistance to
other nearby species of bacteria,
thereby conferring resistance to
their neighbours, which then are
also able to pass on the resistant
gene. This process is
called horizontal gene transfer.
Several mechanisms in attaining multi-drug resistance cont.
23
Antifungal resistance:
(Candida species, Scedosporium prolificans )
Antiparasitic resistance:
(Plasmodium vivax , Toxoplasma gondii, Plasmodium falciparum)
Antiviral resistance:
(HIV, Influenza virus, Cytomegalovirus, Herpes simplex virus)
Other kind of resistance
24
Enterococci are part of the normal
intestinal flora of humans and animals
but are also important pathogens
responsible for serious infections.
E.faecalis and E.faecium are the most
prevalent species cultured from
humans, accounting for more than
90% of clinical isolates. Other
enterococcal species known to cause
human infection include E. avium, E.
gallinarum, E.casseliflavus, E.durans,
E.raffinosus and E.mundtii.[1] E faecium
represents most vancomycin-resistant
enterococci (VRE). Infections include
urinary tract infections, most intra-
abdominal infections, and
uncomplicated wound infections.
ESKAPE group
Enterococcus species
25
MRSA is a type of staph bacteria that is
resistant to certain antibiotics called
beta-lactams. These antibiotics include
methicillin and other more common
antibiotics such as oxacillin, penicillin,
and amoxicillin. MRSA infections are
skin infections. More severe or
potentially life-threatening MRSA
infections occur most frequently among
patients in Healthcare Settings.
S. aureus is a bacterium commonly
found on the skin and in the nose of
about 30% of individuals. Most of the
time, staph does not cause any harm.
These infections can look like pimples,
boils, or other skin conditions and most
are able to be treated.
Methicillin-resistant Staphylococcus
aureus (MRSA)
26
Klebsiella is a type of Gram (-)
bacteria that can cause healthcare-
associated infections including
pneumonia, bloodstream infections,
wound or surgical site infections, and
meningitis. Increasingly, Klebsiella bacteria
have developed antimicrobial resistance,
most recently to the class of antibiotics
known as carbapenems. Klebsiella bacteria
are normally found in the human
intestines (where they do not cause
disease). They are also found in human
stool (feces). In healthcare
settings, Klebsiella infections commonly
occur among sick patients who are
receiving treatment for other conditions.
Patients who have devices like ventilators
(breathing machines) or intravenous (vein)
catheters, and patients who are taking
long courses of certain antibiotics are
most at risk for infections.
Klebsiella pneumoniae
27
Acinetobacter baumannii A. baumannii infection is responsible for
a wide range of infections, including:
pneumonia, bacteraemia, meningitis,
wound infections, urinary tract
infections.
Acinetobacter is a group of bacteria
commonly found in soil and water.
Outbreaks of Acinetobacter infections
typically occur in intensive care units
and healthcare settings housing very ill
patients. While there are many types or
“species” of Acinetobacter and all can
cause human
disease, A.baumannii accounts for
about 80% of reported infections.
28
Pseudomonas aeruginosa
Pseudomonas infection is caused by strains
of bacteria found widely in the
environment; the most common type
causing infections in humans is called P.
aeruginosa. Serious Pseudomonas
infections usually occur in people in the
hospital and/or with weakened immune
systems. Pseudomonal infections can
involve the following parts of the body,
with corresponding symptoms and signs:
Pneumonia, Bacteremia, Endocarditis,
Meningitis, brain abscess, Otitis, Keratitis,
endophthalmitis,Osteomyelitis,Diarrhea,
enteritis, enterocolitis,Urinary tract, Skin
(eg, ecthyma gangrenosum)
29
Enterobacter species
Enterobacter infections can include
bacteremia, lower respiratory tract
infections, skin and soft-tissue
infections, urinary tract
infections (UTIs), endocarditis, intra-
abdominal infections, septic arthritis,
osteomyelitis, CNS infections, and
ophthalmic infections.
Enterobacter species are rod-shaped
bacteria that are found in the
environment and also in the human
intestinal tract. Some species are
pathogenic, the most common being E.
cloacae and E. aerogenes, which can
cause opportunistic infections in
immunocompromised patients.
30
To limit the development of antimicrobial resistance, it has been
suggested to:
 Use the appropriate antimicrobial for an infection; e.g. no
antibiotics for viral infections
 Identify the causative organism whenever possible
 Select an antimicrobial which targets the specific organism, rather
than relying on a broad-spectrum antimicrobial
 Complete an appropriate duration of antimicrobial treatment (not
too short and not too long)
 Use the correct dose for eradication; subtherapeutic dosing is
associated with resistance, as demonstrated in food animals
Preventing the emergence of antimicrobial
resistance
31
32
Prevention of nosocomial infections
Hand washing
33
Prudent use of antibiotics
Isolation & barrier precautions
Decontamination of equipment
Decontamination of environment
Prevention of nosocomial infections
Transparent dressings allow easy monitoring
of wound infection
Infection prevention is the most efficient strategy of
prevention of an infection with a MDR organism within a
hospital, because there are few alternatives to antibiotics in the
case of an extensively resistant or panresistant infection; if an
infection is localized, removal or excision can be attempted
(with MDR-TB the lung for example), but in the case of a
systemic infection only generic measures like boosting the
immune system with immunoglobulins may be possible. The
use of bacteriophages (viruses which kill bacteria) has no
clinical application at the present time.
34
Prevention of nosocomial infections
35
Chlorhexidine - Skin disinfection – Gram positive Gram
negative – moderate, some viruses, fungi
Ethanol – Skin disinfection - 70% (90% for viruses)
Isopropanol – Skin disinfection - 60-70%
Iodine and Iodophors - Skin disinfection - Broad spectrum
Sporicidal
Chloroxylenois - Cuts and abrasions - Gram positive
Hypochlorite solution - Environmental applications- Gram
positive Gram negative, AFB – moderate, bacterial spores,
fungi-moderate
Hydrogen peroxide gas - Environmental applications- Gram
positive Gram negative, AFB , bacterial spores, fungi, viruses
Choice of Disinfectants

Contenu connexe

Tendances

Bacterial drug resistance
Bacterial drug resistanceBacterial drug resistance
Bacterial drug resistanceLuxlakshmi1
 
Multidrug resistance in Microbes
Multidrug resistance in MicrobesMultidrug resistance in Microbes
Multidrug resistance in MicrobesArjun Kumar
 
Bacterial resistance mechanisms and new trends for resistance overcoming
Bacterial resistance mechanisms and new trends for resistance overcoming Bacterial resistance mechanisms and new trends for resistance overcoming
Bacterial resistance mechanisms and new trends for resistance overcoming Mohammed Fawzy
 
Antimicrobial resistance mechanism
Antimicrobial resistance mechanismAntimicrobial resistance mechanism
Antimicrobial resistance mechanismDr Mangala Nischal
 
Immune response to fungal infection
Immune response to fungal infectionImmune response to fungal infection
Immune response to fungal infectionVickyVicrun
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance-
 
Antibiotic resistance dr sachin
Antibiotic resistance dr sachinAntibiotic resistance dr sachin
Antibiotic resistance dr sachinSachin Verma
 
The perspective of antibiotic resistance
The perspective of antibiotic resistanceThe perspective of antibiotic resistance
The perspective of antibiotic resistanceLimon Mirza
 
Antbiotic resistance
Antbiotic resistanceAntbiotic resistance
Antbiotic resistancepodila shree
 
Laboratory Associated Infections
Laboratory Associated InfectionsLaboratory Associated Infections
Laboratory Associated Infections90TrishaR
 
Host pathogen interactions
Host pathogen interactions Host pathogen interactions
Host pathogen interactions Shomu's Biology
 
Antibiotic resistance
Antibiotic resistance Antibiotic resistance
Antibiotic resistance Naser Tadvi
 
Bordetella class notes
Bordetella class notesBordetella class notes
Bordetella class notesBruno Mmassy
 

Tendances (20)

Bacterial drug resistance
Bacterial drug resistanceBacterial drug resistance
Bacterial drug resistance
 
Multidrug resistance in Microbes
Multidrug resistance in MicrobesMultidrug resistance in Microbes
Multidrug resistance in Microbes
 
Bacterial resistance mechanisms and new trends for resistance overcoming
Bacterial resistance mechanisms and new trends for resistance overcoming Bacterial resistance mechanisms and new trends for resistance overcoming
Bacterial resistance mechanisms and new trends for resistance overcoming
 
Antimicrobial resistance mechanism
Antimicrobial resistance mechanismAntimicrobial resistance mechanism
Antimicrobial resistance mechanism
 
Antibiotic resistance
Antibiotic resistanceAntibiotic resistance
Antibiotic resistance
 
Antimicrobial Resistance
Antimicrobial ResistanceAntimicrobial Resistance
Antimicrobial Resistance
 
Immune response to fungal infection
Immune response to fungal infectionImmune response to fungal infection
Immune response to fungal infection
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance
 
Antibiotic resistance dr sachin
Antibiotic resistance dr sachinAntibiotic resistance dr sachin
Antibiotic resistance dr sachin
 
Antibiotics resistance lecture
Antibiotics resistance lectureAntibiotics resistance lecture
Antibiotics resistance lecture
 
The perspective of antibiotic resistance
The perspective of antibiotic resistanceThe perspective of antibiotic resistance
The perspective of antibiotic resistance
 
Multi drug resistanse
Multi drug resistanseMulti drug resistanse
Multi drug resistanse
 
Antbiotic resistance
Antbiotic resistanceAntbiotic resistance
Antbiotic resistance
 
Laboratory Associated Infections
Laboratory Associated InfectionsLaboratory Associated Infections
Laboratory Associated Infections
 
INTERPRETATION OF ANTIBIOGRAMS Trends of Change
INTERPRETATION OF ANTIBIOGRAMSTrends of Change  INTERPRETATION OF ANTIBIOGRAMSTrends of Change
INTERPRETATION OF ANTIBIOGRAMS Trends of Change
 
Host pathogen interactions
Host pathogen interactions Host pathogen interactions
Host pathogen interactions
 
Antibiotic resistance
Antibiotic resistance Antibiotic resistance
Antibiotic resistance
 
Bordetella class notes
Bordetella class notesBordetella class notes
Bordetella class notes
 
Antimicrobial resistance
Antimicrobial resistanceAntimicrobial resistance
Antimicrobial resistance
 
Carbapenamases. facts detection and concerns by Dr.T.V.Rao MD
Carbapenamases. facts detection and concerns by Dr.T.V.Rao MDCarbapenamases. facts detection and concerns by Dr.T.V.Rao MD
Carbapenamases. facts detection and concerns by Dr.T.V.Rao MD
 

Similaire à Healthcare associated infections and eskape pathogens

Threat of antibiotic resistant bacteria to humans
Threat of antibiotic resistant bacteria to humansThreat of antibiotic resistant bacteria to humans
Threat of antibiotic resistant bacteria to humansRBKC
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infectionJasmine John
 
Nosocomial fungal infections
Nosocomial fungal infectionsNosocomial fungal infections
Nosocomial fungal infectionsRoumi Ghosh
 
Hospital acquired infection.pptx
Hospital acquired infection.pptxHospital acquired infection.pptx
Hospital acquired infection.pptxMrsP6
 
Hospital acquired infections
Hospital acquired infectionsHospital acquired infections
Hospital acquired infectionsGiven Sishekano
 
NOSOCOMIAL INFECTION.ppt
NOSOCOMIAL INFECTION.pptNOSOCOMIAL INFECTION.ppt
NOSOCOMIAL INFECTION.pptS A Tabish
 
Nosocomial infection in icu
Nosocomial infection in icuNosocomial infection in icu
Nosocomial infection in icuRuma SEN
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infectionS A Tabish
 
A Study On Multidrug Resistant Disease
A Study On Multidrug Resistant DiseaseA Study On Multidrug Resistant Disease
A Study On Multidrug Resistant DiseaseJulie Brown
 
Pathogenesis of bacterial infection and nosocomial infection
Pathogenesis of bacterial infection and nosocomial infectionPathogenesis of bacterial infection and nosocomial infection
Pathogenesis of bacterial infection and nosocomial infectionRegi Septian
 
Hospital acquired infections and their survival rate
Hospital acquired infections and their survival rateHospital acquired infections and their survival rate
Hospital acquired infections and their survival rateHafsaQasim1
 
Nosocomial Infections by Mohammad Mufarreh
Nosocomial Infections by Mohammad MufarrehNosocomial Infections by Mohammad Mufarreh
Nosocomial Infections by Mohammad MufarrehMMufarreh
 
Carbapenem-Resistant Bacteria
Carbapenem-Resistant BacteriaCarbapenem-Resistant Bacteria
Carbapenem-Resistant BacteriaPE Hardwicke, PhD
 
Introduction to infection control
Introduction to infection control Introduction to infection control
Introduction to infection control Youssef2000
 
Hospital infection control ..............Qasim jan dawar
Hospital infection control ..............Qasim jan dawarHospital infection control ..............Qasim jan dawar
Hospital infection control ..............Qasim jan dawarQasimDawar1
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infectionYoussef2000
 

Similaire à Healthcare associated infections and eskape pathogens (20)

-noscomial.pdf
-noscomial.pdf-noscomial.pdf
-noscomial.pdf
 
Threat of antibiotic resistant bacteria to humans
Threat of antibiotic resistant bacteria to humansThreat of antibiotic resistant bacteria to humans
Threat of antibiotic resistant bacteria to humans
 
INFECTIONS IN ORGAN TRANSPLANT PATIENTS essential learning
INFECTIONS IN ORGAN TRANSPLANT PATIENTS essential learning INFECTIONS IN ORGAN TRANSPLANT PATIENTS essential learning
INFECTIONS IN ORGAN TRANSPLANT PATIENTS essential learning
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infection
 
Nosocomial fungal infections
Nosocomial fungal infectionsNosocomial fungal infections
Nosocomial fungal infections
 
Hospital acquired infection.pptx
Hospital acquired infection.pptxHospital acquired infection.pptx
Hospital acquired infection.pptx
 
Hospital acquired infections
Hospital acquired infectionsHospital acquired infections
Hospital acquired infections
 
Antibiotics
AntibioticsAntibiotics
Antibiotics
 
NOSOCOMIAL INFECTION.ppt
NOSOCOMIAL INFECTION.pptNOSOCOMIAL INFECTION.ppt
NOSOCOMIAL INFECTION.ppt
 
Nosocomial infection in icu
Nosocomial infection in icuNosocomial infection in icu
Nosocomial infection in icu
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infection
 
Nci mdro
Nci mdroNci mdro
Nci mdro
 
A Study On Multidrug Resistant Disease
A Study On Multidrug Resistant DiseaseA Study On Multidrug Resistant Disease
A Study On Multidrug Resistant Disease
 
Pathogenesis of bacterial infection and nosocomial infection
Pathogenesis of bacterial infection and nosocomial infectionPathogenesis of bacterial infection and nosocomial infection
Pathogenesis of bacterial infection and nosocomial infection
 
Hospital acquired infections and their survival rate
Hospital acquired infections and their survival rateHospital acquired infections and their survival rate
Hospital acquired infections and their survival rate
 
Nosocomial Infections by Mohammad Mufarreh
Nosocomial Infections by Mohammad MufarrehNosocomial Infections by Mohammad Mufarreh
Nosocomial Infections by Mohammad Mufarreh
 
Carbapenem-Resistant Bacteria
Carbapenem-Resistant BacteriaCarbapenem-Resistant Bacteria
Carbapenem-Resistant Bacteria
 
Introduction to infection control
Introduction to infection control Introduction to infection control
Introduction to infection control
 
Hospital infection control ..............Qasim jan dawar
Hospital infection control ..............Qasim jan dawarHospital infection control ..............Qasim jan dawar
Hospital infection control ..............Qasim jan dawar
 
Nosocomial infection
Nosocomial infectionNosocomial infection
Nosocomial infection
 

Dernier

Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfDolisha Warbi
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 

Dernier (20)

Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdfPAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
PAIN/CLASSIFICATION AND MANAGEMENT OF PAIN.pdf
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 

Healthcare associated infections and eskape pathogens

  • 1. Healthcare Associated Infections and ESKAPE Pathogens
  • 3. Healthcare Associated Infections (nosocomial) are infections that are acquired as a result of healthcare interventions. There are a number of factors that can increase the risk of acquiring an infection, but high standards of infection control practice minimise the risk of occurrence. A pathogen is a micro-organism that has the potential to cause disease. An infection is the invasion and multiplication of pathogenic microbes in an individual or population. Disease is when the infection causes damage to the individual’s vital functions or systems. Definition 3
  • 5. 5 Nosocomial infections - Infections that are acquired in hospital (>48 hours after admission). They may occur even after discharge. Approx 9% of patients affected – risk increases with length of stay. Significant financial burden on NHS Nosocomial infections are often caused by opportunistic pathogens, i.e. those which do not normally cause infections in healthy people Hospital microorganisms tend to be generally more resistant to antbiotics and are therefore much harder to treat Hospital micro-organisms
  • 6. Organisms in Healthcare Settings and known nosocomial infections: 6 Acinetobacter baumannii Burkholderia cepacia Candida albicans Clostridium difficile Clostridium sordellii Enterobacteriaceae (carbapenem- resistance) Gastroenteritis Hepatitis Pneumonia (Ventilator-associated) HIV Influenza Klebsiella Legionnaires' disease Mycobacterium abscessus Norovirus Pseudomonas aeruginosa Staphylococcus aureus (coag-) Stenotrophomonas maltophilia Tuberculosis (TB) Urinary tract infection Enterococci Extended Spectrum Beta-lactamase producing organisms (ESBL+) Vancomycin Resistant Staphylococcus aureus (VRSA) Vancomycin Resistant Enterococci (VRE) pneumonia Methicillin Resistant Staphylococcus aureus (MRSA) Acinetobacter spp
  • 7. 7 Bloodstream infection (BSI) Hospital-acquired pneumonia (HAP) Surgical site infection (SSI) Urinary tract infection (UTI) Hospital-acquired diarrhoea Most common nosocomial infections Mortality
  • 8. 8 35% Staphylococci (coagulase-negative) 25% Staphylococcus aureus 11.2% Enterococci 9.7% Fungi 6.2% Enterobacter spp 4.9% Pseudomonas spp Bloodstream infections (BSI) Common pathogens
  • 9. 9 Peripheral intravenous line and Central venous catheter (CVC) 43% of all BSI are central line (CVC) related!
  • 10. 10 Ventilator-associated pneumonia Normal chest x-ray Ventilator-associated pneumonia
  • 11. 11 Pneumonia - Infections of the respiratory tract Ventilator
  • 12. 12 Risk factors old age, antibiotic therapy, immunosuppression, chemotherapy and others Diarrhoea Clostridium difficile
  • 13. 13 20% Staphylococcus aureus 16% Pseudomonas spp 15% Staphylococci (coagulase-negative) <10% Enterococcus spp <10% Escherichia coli <10% Enterobacter spp <10% Fungi Surgical site infections Virulence Bacterial dose Impaired host resistance Pathogenesis
  • 14. 14 50% Gram-negative coliforms 25% Fungi 10% Enterococci Urinary Tract Infections (UTI) Common pathogens
  • 15. 15 Transmission of microorganisms Contact – most common • Direct (physical contact) • Indirect (via contaminated objects) Airborne Transmission • Respiratory droplets • Inhalation of infectious particles Blood-borne transmission Food-borne
  • 16. ESKAPE Pathogens Bacterial species from the ESKAPE group (i.e. E.faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa and Enterobacter species) are frequently resistant to antibiotics. "In many respects it’s far worse than MRSA," Antimicrobial resistance among both Gram-positive and Gram-negative bacteria has been on the rise in the past few years. The presence of multidrug-resistant (MDR) pathogens has become a cause for serious concern with regard to nosocomial infections. The most common and threatening MDR pathogens have been grouped together under the acronym ‘ESKAPE,’ which stands for E.faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. 16
  • 17. 17 Risk Factors Patient risk factors Environmental risk factors Hospital micro-organisms Antibiotics Operative risk factors
  • 18. 18 Patient risk factors • Very old or very young • Immunocompromised (HIV+, cancer, chemotherapy, diabetes, alcoholism) • Surgery • Impaired local blood supply (peripheral vascular disease) • Medical devices (urinary catheters, intravascular catheters, prosthetic joints or heart valves, endotracheal tubes etc) • Pre- and Pos-toperative issues • Malnutrition
  • 19. 19 • Contaminated air-conditioning systems (Ventilation ) • Contaminated water systems • Staffing and physical layout of the facility (eg, nurse- to-patient ratio, open beds close together) • Operating room environment • Surgical attire and drapes • Asepsis and surgical technique • Conventional sterilization of surgical instruments Environmental risk factors
  • 20. Multiple drug resistance (MDR) Multiresistance is a condition enabling disease-causing microrganisms (bacteria, viruses, fungi or parasites) to resist distinct antimicrobials, first and foremost antibiotics,but also antifungal drugs, antiviral medications, antiparasitic drugs, chemicals of a wide variety[1] of structure and function targeted at eradicating the organism. 20
  • 21. Bacterial resistance Various microorganisms have survived for thousands of years by their ability to adapt to antimicrobial agents. They do so via spontaneous mutation or by DNA transfer. This process enables some bacteria to oppose the action of certain antibiotics, rendering the antibiotics ineffective. 21
  • 22.  No longer relying on a glycoprotein cell wall  Enzymatic deactivation of antibiotics  Decreased cell wall permeability to antibiotics  Altered target sites of antibiotic  Moving of toxic substances and antibiotics out of the cell[5]  Increased mutation rate as a stress response[6] Several mechanisms in attaining multi-drug resistance: 22
  • 23. Some resistant bacteria are able to transfer copies of DNA that code for a mechanism of resistance to other nearby species of bacteria, thereby conferring resistance to their neighbours, which then are also able to pass on the resistant gene. This process is called horizontal gene transfer. Several mechanisms in attaining multi-drug resistance cont. 23
  • 24. Antifungal resistance: (Candida species, Scedosporium prolificans ) Antiparasitic resistance: (Plasmodium vivax , Toxoplasma gondii, Plasmodium falciparum) Antiviral resistance: (HIV, Influenza virus, Cytomegalovirus, Herpes simplex virus) Other kind of resistance 24
  • 25. Enterococci are part of the normal intestinal flora of humans and animals but are also important pathogens responsible for serious infections. E.faecalis and E.faecium are the most prevalent species cultured from humans, accounting for more than 90% of clinical isolates. Other enterococcal species known to cause human infection include E. avium, E. gallinarum, E.casseliflavus, E.durans, E.raffinosus and E.mundtii.[1] E faecium represents most vancomycin-resistant enterococci (VRE). Infections include urinary tract infections, most intra- abdominal infections, and uncomplicated wound infections. ESKAPE group Enterococcus species 25
  • 26. MRSA is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in Healthcare Settings. S. aureus is a bacterium commonly found on the skin and in the nose of about 30% of individuals. Most of the time, staph does not cause any harm. These infections can look like pimples, boils, or other skin conditions and most are able to be treated. Methicillin-resistant Staphylococcus aureus (MRSA) 26
  • 27. Klebsiella is a type of Gram (-) bacteria that can cause healthcare- associated infections including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems. Klebsiella bacteria are normally found in the human intestines (where they do not cause disease). They are also found in human stool (feces). In healthcare settings, Klebsiella infections commonly occur among sick patients who are receiving treatment for other conditions. Patients who have devices like ventilators (breathing machines) or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for infections. Klebsiella pneumoniae 27
  • 28. Acinetobacter baumannii A. baumannii infection is responsible for a wide range of infections, including: pneumonia, bacteraemia, meningitis, wound infections, urinary tract infections. Acinetobacter is a group of bacteria commonly found in soil and water. Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing very ill patients. While there are many types or “species” of Acinetobacter and all can cause human disease, A.baumannii accounts for about 80% of reported infections. 28
  • 29. Pseudomonas aeruginosa Pseudomonas infection is caused by strains of bacteria found widely in the environment; the most common type causing infections in humans is called P. aeruginosa. Serious Pseudomonas infections usually occur in people in the hospital and/or with weakened immune systems. Pseudomonal infections can involve the following parts of the body, with corresponding symptoms and signs: Pneumonia, Bacteremia, Endocarditis, Meningitis, brain abscess, Otitis, Keratitis, endophthalmitis,Osteomyelitis,Diarrhea, enteritis, enterocolitis,Urinary tract, Skin (eg, ecthyma gangrenosum) 29
  • 30. Enterobacter species Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft-tissue infections, urinary tract infections (UTIs), endocarditis, intra- abdominal infections, septic arthritis, osteomyelitis, CNS infections, and ophthalmic infections. Enterobacter species are rod-shaped bacteria that are found in the environment and also in the human intestinal tract. Some species are pathogenic, the most common being E. cloacae and E. aerogenes, which can cause opportunistic infections in immunocompromised patients. 30
  • 31. To limit the development of antimicrobial resistance, it has been suggested to:  Use the appropriate antimicrobial for an infection; e.g. no antibiotics for viral infections  Identify the causative organism whenever possible  Select an antimicrobial which targets the specific organism, rather than relying on a broad-spectrum antimicrobial  Complete an appropriate duration of antimicrobial treatment (not too short and not too long)  Use the correct dose for eradication; subtherapeutic dosing is associated with resistance, as demonstrated in food animals Preventing the emergence of antimicrobial resistance 31
  • 32. 32 Prevention of nosocomial infections Hand washing
  • 33. 33 Prudent use of antibiotics Isolation & barrier precautions Decontamination of equipment Decontamination of environment Prevention of nosocomial infections Transparent dressings allow easy monitoring of wound infection
  • 34. Infection prevention is the most efficient strategy of prevention of an infection with a MDR organism within a hospital, because there are few alternatives to antibiotics in the case of an extensively resistant or panresistant infection; if an infection is localized, removal or excision can be attempted (with MDR-TB the lung for example), but in the case of a systemic infection only generic measures like boosting the immune system with immunoglobulins may be possible. The use of bacteriophages (viruses which kill bacteria) has no clinical application at the present time. 34 Prevention of nosocomial infections
  • 35. 35 Chlorhexidine - Skin disinfection – Gram positive Gram negative – moderate, some viruses, fungi Ethanol – Skin disinfection - 70% (90% for viruses) Isopropanol – Skin disinfection - 60-70% Iodine and Iodophors - Skin disinfection - Broad spectrum Sporicidal Chloroxylenois - Cuts and abrasions - Gram positive Hypochlorite solution - Environmental applications- Gram positive Gram negative, AFB – moderate, bacterial spores, fungi-moderate Hydrogen peroxide gas - Environmental applications- Gram positive Gram negative, AFB , bacterial spores, fungi, viruses Choice of Disinfectants