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ANTIMICROBIAL RESISTANCE PHENOTYPES IN HOSPITAL ISOLATES Abbreviation of resistant phenotype Resistance mechanism Detection of resistance Non-effective antibiotics prepared by M. Mnichowska-Polanowska Active antibiotics Genus/species Location MSSA Inactivating enzymes (betalactamases: penicillinases) Disc with OX better disc with cefoxitin FOX Classic (natural) penicillins Penicillinase-resistant penicillins (cloxacillin) Staph.aureus MRSA Altered target site (mec A gene→ PBP 2a protein) As above Beta-lactams Glycopeptides, linezolid, aminoglycosides Staph aureus MRCNS VISA As above Altered target ‘Van’ genes As above Disc with VA E-test with VA Discs with erythromycyn and clindamycin As above Beta-lactams, vancomycin Macrolides, lincosamides Streptogramins gr B Aminoglicosydes in high concentartion As above linezolid CNS Staph. aureus other groups staphylococci, streptococci Glycopeptides (mainly teicoplanin), linezolid Enterococci MLSB Attention HLAR Enzymatic modification of antibiotics Disc with gentamycin in high concentration (GN 30) VRE Altered targetsite (Van A-E genes) Disc with VA E-test with VA vancomycin Linezolid, tetracyclines, chloramphenicol Enterococci ESBL Inactivating enzymes (extended spectrum betalactamases); Plasmid -encoded DDT : cephalosporins III gen. (CAZ and CTX) and AMC between them [CAZ-AMC-CTX] Pen; ceph I-IV gen, monobactams carbapenems ; G(-) rods According to EUCAST recommendations: Detection of ESBL does not exclude the use of cef I-IV if was confirmed susceptibility to the drugs in AST Inactivating enzymes derepression of chromosomal betalactamase; Chromosomal and plasmid-encoded DDT + FEP: 2 x cephalosporins III gen, pen/inh between them and ceph. IV gen (FEP) above pen/inh FEP CAZ –AMC - CTX Pen, cef I-III gen, monobactams G(-) rods According to EUCAST recommendations: Detection of ESBL does not exclude the use of cef I-III if was confirmed susceptibility to the drugs in AST discs: 2 x cephalosporins III gen, pen/inh between them and ceph. IV gen above pen/inh carbapenems G(-) rods No drug of proven efficacy and safety; due to AST Most often in: Klebsiella, Enterobacter, Aztreonam; no drug of proven efficacy and safety; due to AST Mostly Pseudomonas AmpC ESBL + AmpC risk of selection of ESBLstrains - pen/inh, ceph I-IV gen, monobactamsCarbapenems, Ceph IV gen risk of selection of ESBLstrains - cef I-III KPC Inactivating enzymes Plasmid-encoded Hodge test – coverleaf test, result: coverleaf –like identation CDT [MEM/ MEM + boronic acid] Pen, pen/inh cef I-IV gen, monobactams beta-lactams (including all the carbapenems) MBL Inactivating enzymes MBL genes encoded in mobile gene elements. DDST [CAZ + EDTA+ IPM] CDT [IPM/ IPM + EDTA ] most beta- lactam carbapenems Natural resistance to cephalosporins and aminoglycosides in low concentation , inability of use of synergystic therapy : b-lactam /glycopeptide + aminoglycoside The mortality due to infections caused by KPC may reach 50%; increased potential to cause outbreaks; GIT – may be reservoir of KPC strains List of abbreviations used in the table. AMC AST CAZ CDT Cef CNS CTX DDT DDST ESBL EUCAST FEP FOX GIT HLAR IPM KPC MBL MEM MSSA MRSA OX VA VISA VRE amoxicillin/clavulanic acid antimicrobial susceptibility testing ceftazidime combined disk test cephalosporins coagulase – negative staphylococci cefotaxime double disk test double disk synergy test extended spectrum beta-lactamase European Comittee on Antimicrobial Susceptibility Testing cefepime cefoxitin gastrointestinal tract high level aminoglicoside resistant imipenem Klebsiella pneumoniae carbapenemase metallo- beta lactamase meropenem meticillin susceptible S. aureus meticillin resistant S. ureus oxacillin vancomycin vancomycin intermidiate S. aureus vancomycin resistant enterococci