BRMO
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Antibiotic resistance
sept. 2014
BRMO ● Definitie BRMO penicilline resistente Streptococcus pneumoniae + penicilline resistente Staphylococcus aureus methicilline resistente Staphylococcus epidermidis methicilline resistente Staphylococcus aureus + co trimoxazole resistente Escherichia coli co trimoxazole resistente Stenotrophomonas maltophilia +
Antibiotic resistance- what is known ● Is increasing ● Is a worldwide problem ● Size of the problem depends on the country the micro organism the antibiotic the availability of relevant data
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Antibiotic resistance- what is known ● Is increasing ● Is a worldwide problem ● Size of the problem depends on the country the micro organism the antibiotic the availability of relevant data
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Antibiotica resistentie - Ontstaan ● Mutatie: in DNA, gebeurt spontaan ook in afwezigheid van antibiotica, ● Selectie: verspreiding, onder invloed van antibiotica gebruik (= selectie druk)
Mechanismen van resistentie ● Verandering van aangrijpingspunt van het antibioticum in de bacterie: methcilline resistentie ● Productie van antibioticum- inactiverende enzymen: beta-lactamases: maken beta- lactam ring in beta-lactam antibiotica kapot, ● Efflux pompen: verandering van permeabiliteit: meer antbioticum eruit dan erin: quinolones
Resistentie - Genetische informatie ● Plasmid – Chromosomaal ● Plasmid makkelijker verspreiding dan Chromosomaal ● Genetische informatie kan overspringen van plasmid naar chromosoom en omgekeerd ● Plasmid: deel van de bacterie vespreidt zich, kan tussen bacterie soorten worden uitgewisseld. ● Chromosoom: bacterie verspreidt zich
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Antibiotic resistance Problem ● Antibiotic resistance: main risk factor Human Antibiotic Use animal use travelling abroad ● Antibiotic use world wide: 50% incorrect: indication, choice and duration 50% unavailable
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Antibiotic resistance Problem ● Antibiotic resistance: main risk factor Human Antibiotic Use animal use travelling abroad ● Antibiotic use world wide: 50% incorrect: indication, choice and duration 50% unavailable
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Optimal Antibiotic use Correct Correct Correct Correct
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indication choice duration administration
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Patient-Hospital population * the patient population * specialism: ICU, gynaecology, surgery, haematology * in – out patients: > or < 48 hours after admittance * in patients: only first isolate or during hospitalisation
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Surveillance studies
“Tools should be developed to provide customer- specific datasets” A. Dalhoff, Infection 2012
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Availability of relevant data ● Surveillance data: “Many resistance surveillance studies suffer from inaccuracies like the sampling of a selected patiënt population hospitalized or after therapy failure the number of national participating centers (mostly limited to one or two participating) restricted geographical sampling undefined requirements of the user( infection control specialist,prescribing physician,microbologist)”
A. Dalhoff, Infection 2012
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Surveillance studies “Most surveillance studies suffer from well recognized but incorrect biases or inaccuracies BUT, they provide important information that allow the identification of trends in pathogen incidence and antimicrobial resistance” A. Dalhoff, Infection 2012
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International Surveillance Programs ● EARS-Net: ECDC, 28 European countries, Increasing resistance of invasive E. coli to all antibiotics Increase in MDR Klebsiella pneumoniae: third generation cephlalosporins: ceftazidime fluoroquinolones: ciprofloxacin aminoglycosides: gentamicin Resistance to Carbapenems: KPC, OXA-48, NDM
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Nationaal surveillance programma ● ● ● ●
ISIS AR Routine data van microbiologische laboratoria, ziekenhuispat. Streven is aansluiting van alle laboratoria Data o.a beschikbaar via NethMap,
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Surveillance studies ● Klinische isolaten: ziekenhuis laboratoria infecties Gram positieven: Staph. aureus en andere Gram negatieven: Enterobacteriaceae en andere ● Surveillance isolates: dragerschap Gram positieven: Staph. aureus - MRSA Gram negatieven: Escherichia coli
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Prevalentie van MRSA bij huisartspatienten
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http://www.traveltip.org/countries_visited.php
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Take home message ● Antibiotica resistentie neemt wereldwijd toe, ook in Nederland ● Resistentie is afhankelijk van micro organisme en van het antibioticum ● Antibiotica gebruik is belangrijke risicofactor voor resistentie ● Optimaal gebruik betekent juiste indicatie, keus , duur en toedieningsweg, ● Juiste keus: relevante surveillance data essentieel ● Voorkomen is beter dan genezen: An ounce of prevention is worth a pound of cure
Antibiotic resistance prevention
What can WE do?
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