Thirty additional patients, despite the...

Multidrug-resistant gram-negative microorganisms, including extended spectrum-lactamase Џ (ESBL) producing pathogens are becoming more complex problem in hospitals, the United States. Karbapenem antibiotics such as meropenem and imipenem were the cornerstone drug for the treatment of severe infections caused by these pathogens. Resistance karbapenemy was unusual so far. Recently, Klebsiella pneumonia

developed a new mechanism of resistance to karbapenemam, known as a PDA, and has caused several outbreaks of infection advanced in the north-eastern region of the United States. What is PPC? K. pneumonia

carbapenemases (SSKP) were first described in 2001 separated from Klebsiella from hospital in North Carolina. CCP enzymes encoded by gene segments that can be transferred between bacteria known as plasmids. Bacteria from the CCP enzymes can inactivate all penicillins, cephalosporins, aztreonam and most importantly karbapenemy. CCP resistance can coexist with other gram-negative resistance mechanisms, including ESBL, fluoroquinolones and aminoglycosides resistance. The problem starts: an outbreak in New York in New York Hospital (Hospital), 2 patients with imipenem-resistant

infection to pneumonia were found in August 2003. Thirty additional patients, despite the escalation of education and increased contact precautions, were identified as imipenem-resistant K. pneumonia

infection over the next six months. With the growth of multidrug-resistant K. pneumonia

message on the New York State Department of Health. Thirty isolates

considered acquired nosocomially. Two residents of nursing homes have been positive results >> << culture within 48 hours of hospitalization, indicating that long-term care facility can be the source of the organism. Links epidemiological cases, however, ultimately, have been identified. Of the 32 cultures with positive results, 12 came from

urine, 7 from sputum, 9 from blood, and 4 from wound specimens. Imipenem-resistant K. pneumonia

December 2003. Two additional patients were subsequently found in the port of imipenem-resistant

Go to pneumonia in 2004. In the course followed

3 months, 24 more patients were identified with sustainable

K. pneumonia infection in the hospital. The outbreak investigation showed that all isolates

acquired nosocomially, with average >> << duration of hospital stay a positive culture of 18 days. Results, 6 originated from urine, 4 from sputum, 13 from blood,

, and 4 from wound specimens. Investigation for hospital outbreaks have been published in Archives of Internal Medicine in 2005. identified in the study, 32 patients from the hospital

, and 23 patients from hospital B) and made the following comments:

included ftorhynolonov therapy in 36 patients (60%) and antibiotics

, fluoroquinolones, aminoglycosides and

The problem is growing: the spread of resistance CCP CCP resistance have been reported in other states (New Jersey, Pennsylvania, Florida, GA, MD, California, Ohio), including North Carolina. P CPC resistance also reported around the world in Israel, China

,

South America

and France. Finally, a plasmid that carries a PDA gene resistance is transmitted to other gram-negative bacteria, including Enterobacter,

K. oxytoca, Pseudomonas

,

Escherichia coli, and S.

marcescens. Laboratory implications of CCP CCP resistance of organisms can be detected by conventional laboratory methods. Standard broth

mikrorozveden method is prone to seeding effect when the MIC isolates associated with sowing size. Ertapenem does not seem to be influenced by this effect and has the highest sensitivity for PDA support. Several studies support the use of ertapenem as a laboratory standard Pocket PC screen activity. The best method for detecting SSKP not yet determined. There is an additional level of complexity as screening for other organisms such as ESBL resistance. This multistage process is time consuming and difficult without the use of molecular methods. Management implications for PDAs organisms. The organisms tend to resist the CCP only a few antibiotics. Kolistyn Tigecycline and two types of drugs that have activity, but also have some limitations. Kolistyn associated with nephrotoxicity. There is only limited data on Tigecycline use in complex intra-abdominal infections by ESBL organism. In addition, Tigecycline may not be effective for Gram-negative bacteremia with resistant organisms due to low levels of drugs. Aminoglycosides, when receptive, can be used as a supplement to antibiotics one of the two antibiotics as described above cheap strattera. Ototoksychnist and nephrotoxicity, however, may limit the use of these drugs in patients with multiple concomitant diseases. CCP Main organisms with resistance CCP increasingly widespread. A member of the hospital, most likely, will import or nosocomial cases in the near future. SSKP add support for evidence-based antibiohrammoy antibiotics and antibiotic medium. Infections, PDA organisms usually occur in patients with multiple concomitant diseases. Mortality associated with PDA infection above. Laboratory methods for determining the resistance of the CCP has formalized. CCP infection have very limited therapeutic options. PDA flash usually clonal. Increasing isolation precautions and hand hygiene are crucial for proliferation. .