Dissecting the epidemiology of resistant Enterobacteriaceae and non-fermenters

Size: px
Start display at page:

Download "Dissecting the epidemiology of resistant Enterobacteriaceae and non-fermenters"

Transcription

1 Dissecting the epidemiology of resistant Enterobacteriaceae and non-fermenters Jon Otter, PhD Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London & Guy's and St. Thomas' NHS Foundation Trust, London,

2 Disclosures I am employed part-time by Bioquell. I have received payment for producing educational material for 3M. Research funding from Pfizer and the Guy s & St Thomas Charity.

3

4 Acronym minefield CPC CPE MDR-GNR ESBL MDR-GNB CRO CPE CRE CRC KPC CRAB

5 MRSA is a CRO!

6

7 Resistant Enterobacteriaceae v non-fermenters Enterobacteriaceae (K. pneumoniae) Non-fermenters (A. baumannii) At-risk population Primarily acute pts ICU, burns Risk factors Travel Trauma, ICU stay Epidemic potential High Low Clinical manifestation UTI VAP Attributable mortality Stark increase (CPE) Minimal increase Prevalence Emerging (rapidly) Patchy but stable Sites of colonisation GI tract Resp, GI, skin Colonization duration Months to >1 year Days to weeks Transmission routes Hands ++, Env +/- Hands +, Env ++ Resistance Mainly acquired Intrinsic & acquired Common clones KPC-producing ST258 Intl clones I-III

8 Risk factors & at-risk population Risk factors At-risk population Enterobacteriaceae LOS ICU stay Catheters / devices Ventilation Prior antibiotics Travel Patients in acute settings, particularly those with recent travel to areas of high prevalence. Potential for community spread. Non-fermenters LOS ICU stay Catheters / devices Ventilation Prior antibiotics Trauma (esp. burns) High-risk patients in the ICU and burns units; rare cause of communityacquired infection. ECDC CPE risk assessment, Peleg et al. Clin Microbiol Rev 2008;21:

9 % HCAI Clinical manifestation Enterobacteriaceae Non-Enterobacteriaceae Klebsiella spp. Acinetobacter spp. Zarb et al. ECDC PPS. Euro Surveill 2012;17.

10 Attributable mortality Enterobacteriaceae Non fermenters Organism AmpC / ESBL CPE A. baumannii Attributable mortality Moderate Massive (>50%) Minimal Shorr et al. Crit Care Med 2009;37: Patel et al. ICHE 2008;29:

11 Invasive CR P. aeruginosa isolates (EARS-Net)

12 Invasive CR K. pneumoniae isolates (EARS-Net)

13 CR K.pneumoniae invasive isolates Invasive CR K. pneumoniae trends Greece Italy UK 70% 60% 50% 40% 30% 20% 10% 0% ECDC EARS-Net

14 CR P. aeruginosa invasive isolates (EARS- Net) CR A. baumannii bacteraemias (PHE) Invasive CR non-fermenters trends Greece - CRPA UK - CRPA Italy - CRPA UK - CRAB 60% 60% 50% 40% 30% 20% 10% 50% 40% 30% 20% 10% 0% 0% % P. aeruginosa: ECDC EARS-Net A. baumannii: PHE Health Protection Report 2013;7.

15 Emergence of CPE in the UK PHE Advice on carbapenemase producers.

16 % CRE CRE in the USA K. pneumoniae / oxytoca All Enterobacteriaceae NHSN / NNIS data; MMWR 2013;62:

17 % carbapenem resistant CRE and CRNF in the USA Central line-associated bloodstream infection (CLABSI) resistant to carbapenems in the national NHSN network K. pneumoniae P. aeruginoas A. baumannii Siivert et al. Infect Control Hosp Epidemiol 2013;34:1-14.

18 % CRE carriers CRE in the USA Long Term Acute Care (LTAC) ICU LTAC Lin et al. Clin Infect Dis 2013;57:

19 % resistant to carbapenems Latin America carbapenem resistance Klebsiella spp A. baumannii P. aeruginosa

20 Sites of colonisation 103 CRAB patients 69% sternal skin 80% tracheal aspirate 25% urine 69% rectal Apisarnthanarak et al. Clin Infect Dis 2013;56:

21 % patients carrying CRKP Duration of colonisation - CRKP Rectal or stool specimens from 103 CRKP patients over 24 months Range of colonisation duration 6-42 days for A. baumannii. 2 1 month 3 months 6 months 12 months 24 months 1. Lubert et al. Am J Infect Control 2014;42: Dijkshoorn et al. Epidemiol Infect 1987;99:

22 Log (10) cfu / disc Surface survival C. difficile Acinetobacter K. pneumoniae Time / weeks Otter & French. J Clin Microbiol 2009;47:

23 Odds ratio Enterobacteriaceae are less environmental Nseir A.baumannii Nseir P.aeruginosa Nseir ESBL Ajao ESBL Nseir et al. Clin Microbiol Infect 2011;17: Ajao et al. Infect Control Hosp Epidemiol 2013;34:

24 Key questions Which interventions work? Are they different for Enterobacteriaceae and nonfermenters? (Probably, given their epidemiology.) Has our focus on CPE taken our eye off CPNF, which are the clear and present danger for many of us? What is the prevalence of CPE in the UK? How much do we believe a single negative screen? Do we need rapid molecular diagnostics? What is the duration of colonisation? Are there decolonisation strategies other than selective decontamination using abx?

25 Share Gram stain reaction Concerning AMR Differ Risk factors & at-risk population Potential for epidemic spread Infection profile & mortality Prevalence Colonisation site & duration Transmission routes Resistance profile & mechanisms

26 Summary 1.Resistant Gram-negative rods represent a more serious threat than the usual suspects, mainly due to the threat of pan-drug resistance. 2.Enterobacteriaceae (mainly K. pneumoniae) and non-fermenters (mainly A. baumannii) have fundamental differences in their epidemiology. 3.CRE and CRNF are both emerging problems, but they are not the same problem. CRO 4.The prevention and control strategy will look different for Enterobacteriaceae vs. nonfermenters.

27 Image credits Danger! Mines! by Save the Wild UP. Chalk and Cheese by Jackson Boyle. All images sourced under a creative commons license from Flikr.

Carbapenem resistant Enterobacteriaceae how do we cope with them clinically?

Carbapenem resistant Enterobacteriaceae how do we cope with them clinically? Carbapenem resistant Enterobacteriaceae how do we cope with them clinically? Dr Kathleen (Kathy) Bamford, Infection Head of Specialty and Deputy Director Infection Prevention and Control, Imperial College

More information

MDRO in LTCF: Forming Networks to Control the Problem

MDRO in LTCF: Forming Networks to Control the Problem MDRO in LTCF: Forming Networks to Control the Problem Suzanne F. Bradley, M.D. Professor of Internal Medicine Division of Infectious Disease University of Michigan Medical School VA Ann Arbor Healthcare

More information

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal

Preventing Multi-Drug Resistant Organism (MDRO) Infections. For National Patient Safety Goal Preventing Multi-Drug Resistant Organism (MDRO) Infections For National Patient Safety Goal 07.03.01 2009 Methicillin Resistant Staphlococcus aureus (MRSA) About 3-8% of the population at large is a carrier

More information

Lindsay E. Nicolle University of Manitoba Winnipeg, CANADA

Lindsay E. Nicolle University of Manitoba Winnipeg, CANADA Lindsay E. Nicolle University of Manitoba Winnipeg, CANADA Long Term Care Facilities: Spectrum low acuity assisted living mobile independent Not LTAC high acuity complete functional disability dialysis

More information

Mono- versus Bitherapy for Management of HAP/VAP in the ICU

Mono- versus Bitherapy for Management of HAP/VAP in the ICU Mono- versus Bitherapy for Management of HAP/VAP in the ICU Jean Chastre, www.reamedpitie.com Conflicts of interest: Consulting or Lecture fees: Nektar-Bayer, Pfizer, Brahms, Sanofi- Aventis, Janssen-Cilag,

More information

Does Screening for MRSA Colonization Have A Role In Healthcare-Associated Infection Prevention Programs?

Does Screening for MRSA Colonization Have A Role In Healthcare-Associated Infection Prevention Programs? Does Screening for MRSA Colonization Have A Role In Healthcare-Associated Infection Prevention Programs? John A. Jernigan, MD, MS Division of Healthcare Quality Promotion Centers for Disease Control and

More information

Multidrug-Resistant Organisms: How Do We Define them? How do We Stop Them?

Multidrug-Resistant Organisms: How Do We Define them? How do We Stop Them? Multidrug-Resistant Organisms: How Do We Define them? How do We Stop Them? Roberta B. Carey, PhD Centers for Disease Control and Prevention Division of Healthcare Quality Promotion Why worry? MDROs Clinical

More information

(DRAFT) RECOMMENDATIONS FOR THE CONTROL OF MULTI-DRUG RESISTANT GRAM-NEGATIVES: CARBAPENEM RESISTANT ENTEROBACTERIACEAE

(DRAFT) RECOMMENDATIONS FOR THE CONTROL OF MULTI-DRUG RESISTANT GRAM-NEGATIVES: CARBAPENEM RESISTANT ENTEROBACTERIACEAE (DRAFT) RECOMMENDATIONS FOR THE CONTROL OF MULTI-DRUG RESISTANT GRAM-NEGATIVES: CARBAPENEM RESISTANT ENTEROBACTERIACEAE John Ferguson (Hunter New England, NSW) on behalf of MRGN Task Force Acknowledgement

More information

Hospital Acquired Infections in the Era of Antimicrobial Resistance

Hospital Acquired Infections in the Era of Antimicrobial Resistance Hospital Acquired Infections in the Era of Antimicrobial Resistance Datuk Dr Christopher KC Lee Infectious Diseases Unit Department of Medicine Sungai Buloh Hospital Patient Story 23 Year old female admitted

More information

03/09/2014. Infection Prevention and Control A Foundation Course. Talk outline

03/09/2014. Infection Prevention and Control A Foundation Course. Talk outline Infection Prevention and Control A Foundation Course 2014 What is healthcare-associated infection (HCAI), antimicrobial resistance (AMR) and multi-drug resistant organisms (MDROs)? Why we should be worried?

More information

1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection

1/30/ Division of Disease Control and Health Protection. Division of Disease Control and Health Protection Surveillance, Outbreaks, and Reportable Diseases, Oh My! Assisted Living Facility, Nursing Home and Surveyor Infection Prevention Training February 2015 A.C. Burke, MA, CIC Health Care-Associated Infection

More information

Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC

Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC Florida Health Care Association District 2 January 13, 2015 A.C. Burke, MA, CIC 11/20/2014 1 To describe carbapenem-resistant Enterobacteriaceae. To identify laboratory detection standards for carbapenem-resistant

More information

The Hospital Environment as a Source of Resistant Gram Negatives

The Hospital Environment as a Source of Resistant Gram Negatives Avondale College ResearchOnline@Avondale Nursing and Health Conference Papers Faculty of Nursing and Health 2013 The Hospital Environment as a Source of Resistant Gram Negatives Brett G. Mitchell Avondale

More information

Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S

Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S CRE Enterobacteriaceae (Gram Negative Bacilli) Citrobacter species Escherichia coli***

More information

Carbapenemase-Producing Enterobacteriaceae (CPE)

Carbapenemase-Producing Enterobacteriaceae (CPE) Carbapenemase-Producing Enterobacteriaceae (CPE) September 21, 2017 Maryam Khan Peel Public Health Madeleine Ashcroft Public Health Ontario Objectives Differentiate the acronyms related to CPE (CPE,CPO,CRE,CRO)

More information

Antimicrobial Cycling. Donald E Low University of Toronto

Antimicrobial Cycling. Donald E Low University of Toronto Antimicrobial Cycling Donald E Low University of Toronto Bad Bugs, No Drugs 1 The Antimicrobial Availability Task Force of the IDSA 1 identified as particularly problematic pathogens A. baumannii and

More information

DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA

DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA DR. MICHAEL A. BORG DIRECTOR OF INFECTION PREVENTION & CONTROL MATER DEI HOSPITAL - MALTA The good old days The dread (of) infections that used to rage through the whole communities is muted Their retreat

More information

Nosocomial Infections: What Are the Unmet Needs

Nosocomial Infections: What Are the Unmet Needs Nosocomial Infections: What Are the Unmet Needs Jean Chastre, MD Service de Réanimation Médicale Hôpital Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, Paris 6, France www.reamedpitie.com

More information

MDR Acinetobacter baumannii. Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta

MDR Acinetobacter baumannii. Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta MDR Acinetobacter baumannii Has the post antibiotic era arrived? Dr. Michael A. Borg Infection Control Dept Mater Dei Hospital Malta 1 The Armageddon recipe Transmissible organism with prolonged environmental

More information

4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES

4/3/2017 CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA DISCLOSURE LEARNING OBJECTIVES CLINICAL PEARLS: UPDATES IN THE MANAGEMENT OF NOSOCOMIAL PNEUMONIA BILLIE BARTEL, PHARMD, BCCCP APRIL 7 TH, 2017 DISCLOSURE I have had no financial relationship over the past 12 months with any commercial

More information

Surveillance cultures: Can they help our decisions

Surveillance cultures: Can they help our decisions Surveillance cultures: Can they help our decisions Trish M. Perl MD, MSc Professor of Medicine, Pathology and Epidemiology Johns Hopkins School of Medicine and Bloomberg School of Public Health tperl@jhmi.edu

More information

Surveillance of AMR in PHE: a multidisciplinary,

Surveillance of AMR in PHE: a multidisciplinary, Surveillance of AMR in PHE: a multidisciplinary, integrated approach Professor Neil Woodford Antimicrobial Resistance & Healthcare Associated Infections (AMRHAI) Reference Unit Crown copyright International

More information

Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED Printed copies must not be considered the definitive version

Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED Printed copies must not be considered the definitive version Multi-Drug Resistant Gram Negative Organisms POLICY REVIEW DATE EXTENDED 2018 Printed copies must not be considered the definitive version DOCUMENT CONTROL POLICY NO. IC-122 Policy Group Infection Control

More information

Other Enterobacteriaceae

Other Enterobacteriaceae GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 50: Other Enterobacteriaceae Author Kalisvar Marimuthu, MD Chapter Editor Michelle Doll, MD, MPH Topic Outline Topic outline - Key Issues Known

More information

A snapshot of polymyxin use around the world South America

A snapshot of polymyxin use around the world South America A snapshot of polymyxin use around the world South America Alexandre P. Zavascki Infectious Diseases Service, Hospital de Clínicas de Porto Alegre Medical School, Federal University of Rio Grande do Sul

More information

Risk of organism acquisition from prior room occupants: A systematic review and meta analysis

Risk of organism acquisition from prior room occupants: A systematic review and meta analysis Risk of organism acquisition from prior room occupants: A systematic review and meta analysis A/Professor Brett Mitchell 1-2 Dr Stephanie Dancer 3 Dr Malcolm Anderson 1 Emily Dehn 1 1 Avondale College;

More information

Antimicrobial resistance (EARS-Net)

Antimicrobial resistance (EARS-Net) SURVEILLANCE REPORT Annual Epidemiological Report for 2014 Antimicrobial resistance (EARS-Net) Key facts Over the last four years (2011 to 2014), the percentages of Klebsiella pneumoniae resistant to fluoroquinolones,

More information

11/22/2016. Hospital-acquired Infections Update Disclosures. Outline. No conflicts of interest to disclose. Hot topics:

11/22/2016. Hospital-acquired Infections Update Disclosures. Outline. No conflicts of interest to disclose. Hot topics: Hospital-acquired Infections Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University

More information

Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Activity C: ELC Prevention Collaboratives

Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Activity C: ELC Prevention Collaboratives Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Activity C: ELC Prevention Collaboratives John Jernigan, MD, MS Alex Kallen, MD, MPH Division of Healthcare Quality Promotion Centers for Disease

More information

Appropriate antimicrobial therapy in HAP: What does this mean?

Appropriate antimicrobial therapy in HAP: What does this mean? Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,

More information

Carbapenemase-Producing Enterobacteriaceae Multi Drug Resistant Organism Management Procedure. (IPC Manual)

Carbapenemase-Producing Enterobacteriaceae Multi Drug Resistant Organism Management Procedure. (IPC Manual) Carbapenemase-Producing Enterobacteriaceae Multi Drug Resistant Organism Management Procedure (IPC Manual) DOCUMENT CONTROL: Version: 1 Ratified by: Clinical Policies Review and Approval Group Date ratified:

More information

Multi-drug resistant Acinetobacter (MDRA) Surveillance and Control. Alison Holmes

Multi-drug resistant Acinetobacter (MDRA) Surveillance and Control. Alison Holmes Multi-drug resistant Acinetobacter (MDRA) Surveillance and Control Alison Holmes The organism and it s epidemiology Surveillance Control What is it? What is it? What is it? What is it? Acinetobacter :

More information

Infection Prevention Highlights for the Medical Staff. Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention

Infection Prevention Highlights for the Medical Staff. Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention Highlights for the Medical Staff Pamela Rohrbach MSN, RN, CIC Director of Infection Prevention Standard Precautions every patient every time a. Hand Hygiene b. Use of Personal Protective Equipment (PPE)

More information

Surveillance of Antimicrobial Resistance among Bacterial Pathogens Isolated from Hospitalized Patients at Chiang Mai University Hospital,

Surveillance of Antimicrobial Resistance among Bacterial Pathogens Isolated from Hospitalized Patients at Chiang Mai University Hospital, Original Article Vol. 28 No. 1 Surveillance of Antimicrobial Resistance:- Chaiwarith R, et al. 3 Surveillance of Antimicrobial Resistance among Bacterial Pathogens Isolated from Hospitalized Patients at

More information

OAHHS Webinar. Christopher D. Pfeiffer, MD, MHS April 30, 2014

OAHHS Webinar. Christopher D. Pfeiffer, MD, MHS April 30, 2014 OAHHS Webinar Christopher D. Pfeiffer, MD, MHS April 30, 2014 Learning Objectives / Outline 1. Understand: What are CRE? Which CRE are most important? Why? 2. Learn about CRE epidemiology, nationally and

More information

Int.J.Curr.Microbiol.App.Sci (2017) 6(3):

Int.J.Curr.Microbiol.App.Sci (2017) 6(3): International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 3 (2017) pp. 891-895 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.603.104

More information

Summary of the latest data on antibiotic resistance in the European Union

Summary of the latest data on antibiotic resistance in the European Union Summary of the latest data on antibiotic resistance in the European Union EARS-Net surveillance data November 2017 For most bacteria reported to the European Antimicrobial Resistance Surveillance Network

More information

28/08/2017. Infection Prevention and Control. Safe Patient Care Bugs and Drugs The ongoing challenge of MDROs and AMR

28/08/2017. Infection Prevention and Control. Safe Patient Care Bugs and Drugs The ongoing challenge of MDROs and AMR Safe Patient Care Bugs and Drugs The ongoing challenge of MDROs and AMR 2017 Safe Patient Care 2017: The Ongoing Challenge of MDROs and AMR Management of the Patient Environment in relation to Multidrug

More information

Multi-drug resistant microorganisms

Multi-drug resistant microorganisms Multi-drug resistant microorganisms Arzu TOPELI Director of MICU Hacettepe University Faculty of Medicine, Ankara-Turkey Council Member of WFSICCM Deaths in the US declined by 220 per 100,000 with the

More information

Safe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times

Safe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University

More information

Surveillance of Multi-Drug Resistant Organisms

Surveillance of Multi-Drug Resistant Organisms Surveillance of Multi-Drug Resistant Organisms Karen Hoffmann, RN, MS, CIC Associate Director Statewide Program for Infection Control and Epidemiology (SPICE) University of North Carolina School of Medicine

More information

Antibiotic Resistance in the Post-Acute and Long-Term Care Settings: Strategies for Stewardship

Antibiotic Resistance in the Post-Acute and Long-Term Care Settings: Strategies for Stewardship Antibiotic Resistance in the Post-Acute and Long-Term Care Settings: Strategies for Stewardship J. Hudson Garrett Jr., PhD, MSN, MPH, FNP-BC, PLNC, CDONA, IP-BC, GDCN, CDP, CADDCT, CALN, VA-BC, AS-BC,

More information

New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs

New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs Patrick R. Murray, PhD Senior Director, WW Scientific Affairs 2017 BD. BD, the BD Logo and all other trademarks

More information

Presenter: Ombeva Malande. Red Cross Children's Hospital Paed ID /University of Cape Town Friday 6 November 2015: Session:- Paediatric ID Update

Presenter: Ombeva Malande. Red Cross Children's Hospital Paed ID /University of Cape Town Friday 6 November 2015: Session:- Paediatric ID Update Emergence of invasive Carbapenem Resistant Enterobacteriaceae CRE infection at RCWMCH Ombeva Oliver Malande, Annerie du Plessis, Colleen Bamford, Brian Eley Presenter: Ombeva Malande Red Cross Children's

More information

Multi-Drug Resistant Organisms (MDRO)

Multi-Drug Resistant Organisms (MDRO) Multi-Drug Resistant Organisms (MDRO) 2016 What are MDROs? Multi-drug resistant organisms, or MDROs, are bacteria resistant to current antibiotic therapy and therefore difficult to treat. MDROs can cause

More information

Preventing and Responding to Antibiotic Resistant Infections in New Hampshire

Preventing and Responding to Antibiotic Resistant Infections in New Hampshire Preventing and Responding to Antibiotic Resistant Infections in New Hampshire Benjamin P. Chan, MD, MPH NH Dept. of Health & Human Services Division of Public Health Services May 23, 2017 To bring a greater

More information

Birgit Ross Hospital Hygiene University Hospital Essen Essen, Germany. Should we screen for multiresistant gramnegative Bacteria?

Birgit Ross Hospital Hygiene University Hospital Essen Essen, Germany. Should we screen for multiresistant gramnegative Bacteria? Birgit Ross Hospital Hygiene University Hospital Essen Essen, Germany Should we screen for multiresistant gramnegative Bacteria? CONCLUSIONS: A program of universal surveillance, contact precautions,

More information

APIC CHAPTER PRESENTATION 7/2014

APIC CHAPTER PRESENTATION 7/2014 2014 CRE THE SUPER BUG - WHY ALL THE BUZZ? Susan Burns BS, MT, CIC, VA-BC Medical Science Liaison DISCLOSURE I am a paid employee of the clinical team of PDI Healthcare. The content of this presentation

More information

Antimicrobial Stewardship

Antimicrobial Stewardship Antimicrobial Stewardship Background Why Antimicrobial Stewardship 30-50% of antibiotic use in hospitals are unnecessary or inappropriate Appropriate antimicrobial use is a medication-safety and patient-safety

More information

RESISTANT PATHOGENS. John E. Mazuski, MD, PhD Professor of Surgery

RESISTANT PATHOGENS. John E. Mazuski, MD, PhD Professor of Surgery RESISTANT PATHOGENS John E. Mazuski, MD, PhD Professor of Surgery Disclosures Contracted Research: AstraZeneca, Bayer, Merck. Advisory Boards/Consultant: Allergan (Actavis, Forest Laboratories), AstraZeneca,

More information

Hosted by Dr. Jon Otter, Guys & St. Thomas Hospital, King s College, London A Webber Training Teleclass 1

Hosted by Dr. Jon Otter, Guys & St. Thomas Hospital, King s College, London A Webber Training Teleclass   1 Andreas Voss, MD, PhD Professor of Infection Control Radboud University Nijmegen Medical Centre & Canisius-Wilhelmina Hospital Nijmegen, Netherlands Hosted by Dr. Jon O0er Guys & St. Thomas NHS Founda

More information

Impact of Antimicrobial Resistance on Human Health. Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital

Impact of Antimicrobial Resistance on Human Health. Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital Impact of Antimicrobial Resistance on Human Health Robert Cunney HSE HCAI/AMR Programme and Temple Street Children s University Hospital AMR in Foodchain Conference, UCD, Dec 2014 Sir Patrick Dun s Hospital

More information

Antibiotic Stewardship in the Hospital Setting

Antibiotic Stewardship in the Hospital Setting Antibiotic Stewardship in the Hospital Setting G. Evans, MD FRCPC Medical Director, Infection Prevention & Control Kingston General Hospital & Hotel Dieu Hospital EOPIC September 26, 2012 Stewardship stew-ard-ship

More information

Infection Prevention and Control Policy

Infection Prevention and Control Policy Infection Prevention and Control Policy Control of Multi-Drug-Resistant Gram-Negative Bacilli N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed

More information

Is biocide resistance already a clinical problem?

Is biocide resistance already a clinical problem? Is biocide resistance already a clinical problem? Stephan Harbarth, MD MS University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Important points Biocide resistance exists Antibiotic

More information

3/1/2016. Antibiotics --When Less is More. Most Urgent Threats. Serious Threats

3/1/2016. Antibiotics --When Less is More. Most Urgent Threats. Serious Threats Antibiotics --When Less is More Ralph Gonzales, MD, MSPH Associate Dean, Clinical Innovation School of Medicine VP, Clinical Innovation, UCSF Health Most Urgent Threats Serious Threats Multidrug-Resistant

More information

EARS Net Report, Quarter

EARS Net Report, Quarter EARS Net Report, Quarter 4 213 March 214 Key Points for 213* Escherichia coli: The proportion of patients with invasive infections caused by E. coli producing extended spectrum β lactamases (ESBLs) increased

More information

Summary of unmet need guidance and statistical challenges

Summary of unmet need guidance and statistical challenges Summary of unmet need guidance and statistical challenges Daniel B. Rubin, PhD Statistical Reviewer Division of Biometrics IV Office of Biostatistics, CDER, FDA 1 Disclaimer This presentation reflects

More information

English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR)

English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Berit Muller-Pebody HCAI & AMR Department, Centre for Infectious Disease Surveillance and Control Chief Medical Officer

More information

FIS Resistance Surveillance: The UK Landscape. Alasdair MacGowan Chair BSAC Working Party on Antimicrobial Resistance Surveillance

FIS Resistance Surveillance: The UK Landscape. Alasdair MacGowan Chair BSAC Working Party on Antimicrobial Resistance Surveillance FIS 2013 Resistance Surveillance: The UK Landscape Alasdair MacGowan Chair BSAC Working Party on Antimicrobial Resistance Surveillance A statement of the obvious Good quality surveillance data on resistant

More information

AMR epidemiological situation: ECDC update

AMR epidemiological situation: ECDC update One Health Network on Antimicrobial Resistance (AMR) AMR epidemiological situation: ECDC update Dominique L. Monnet, on behalf of ECDC Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI)

More information

ECDC activities on antimicrobial resistance & healthcare-associated infections (ARHAI Programme) Ülla-Karin Nurm, ECDC Tallinn, 13 May 2013

ECDC activities on antimicrobial resistance & healthcare-associated infections (ARHAI Programme) Ülla-Karin Nurm, ECDC Tallinn, 13 May 2013 ECDC activities on antimicrobial resistance & healthcare-associated infections (ARHAI Programme) Ülla-Karin Nurm, ECDC Tallinn, 13 May 2013 What is the European Union? 27 Member States 24 official languages

More information

Taking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 1 Reviewing the organisms

Taking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 1 Reviewing the organisms Taking Action to Prevent and Manage Multidrug-resistant Organisms and C. difficile in the Nursing Home: Part 1 Reviewing the organisms Nimalie D. Stone, MD,MS Division of Healthcare Quality Promotion National

More information

Traveling (resistant) bacteria

Traveling (resistant) bacteria Traveling resistant bacteria Erika Vlieghe Institute of Tropical Medicine, Antwerp University Hospital Antwerp Traveling (resistant) bacteria Colonisation - carriership rectal flora, skin Infection: mild-moderate

More information

The Rise of Antibiotic Resistance: Is It Too Late?

The Rise of Antibiotic Resistance: Is It Too Late? The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the

More information

Prevention and control of antimicrobial resistance in healthcare settings: raising awareness about best practices

Prevention and control of antimicrobial resistance in healthcare settings: raising awareness about best practices Prevention and control of antimicrobial resistance in healthcare settings: raising awareness about best practices Dominique L. Monnet, on behalf of ECDC Antimicrobial Resistance and Healthcare-Associated

More information

Prevention, Management, and Reporting of Carbapenem-Resistant Enterobacteriaceae

Prevention, Management, and Reporting of Carbapenem-Resistant Enterobacteriaceae Prevention, Management, and Reporting of Carbapenem-Resistant Enterobacteriaceae Dawn Terashita MD, MPH Acute Communicable Disease Control Los Angeles County Department of Public Health September 28, 2017

More information

Evaluating the Role of MRSA Nasal Swabs

Evaluating the Role of MRSA Nasal Swabs Evaluating the Role of MRSA Nasal Swabs Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds February 28, 2017 2016 MFMER slide-1 Objectives Identify the pathophysiology of MRSA nasal colonization

More information

Fighting MDR Pathogens in the ICU

Fighting MDR Pathogens in the ICU Fighting MDR Pathogens in the ICU Dr. Murat Akova Hacettepe University School of Medicine, Department of Infectious Diseases, Ankara, Turkey 1 50.000 deaths each year in US and Europe due to antimicrobial

More information

Jump Starting Antimicrobial Stewardship

Jump Starting Antimicrobial Stewardship Jump Starting Antimicrobial Stewardship Amanda C. Hansen, PharmD Pharmacy Operations Manager Carilion Roanoke Memorial Hospital Roanoke, Virginia March 16, 2011 Objectives Discuss guidelines for developing

More information

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust

Dr Eleri Davies. Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Dr Eleri Davies Consultant Microbiologist and Infection Control Doctor, Public Health Wales NHS Trust Antimicrobial stewardship What is it? Why is it important? Treatment and management of catheter-associated

More information

Antibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011

Antibiotic Resistance. Antibiotic Resistance: A Growing Concern. Antibiotic resistance is not new 3/21/2011 Antibiotic Resistance Antibiotic Resistance: A Growing Concern Judy Ptak RN MSN Infection Prevention Practitioner Dartmouth-Hitchcock Medical Center Lebanon, NH Occurs when a microorganism fails to respond

More information

9.4 Antimicrobial Resistance

9.4 Antimicrobial Resistance 9.4 Antimicrobial Resistance a) Key Pathogens causing Bloodstream Infections 2016 Summary Estimated 99% coverage of the Irish population versus 97% in 2015 There were 3,057 reports of invasive E. coli

More information

Introduction to antimicrobial resistance

Introduction to antimicrobial resistance Introduction to antimicrobial resistance Philip Howard Consultant Antimicrobial Pharmacist HCAI and AMR Project Lead 4 th March 2015 What is antimicrobial resistance? Antibacterials either kill or stop

More information

Summary of the latest data on antibiotic consumption in the European Union

Summary of the latest data on antibiotic consumption in the European Union Summary of the latest data on antibiotic consumption in the European Union ESAC-Net surveillance data November 2016 Provision of reliable and comparable national antimicrobial consumption data is a prerequisite

More information

Hospital Acquired Infections. Anucha Apisarnthanarak, MD Infectious Disease Division Thammasart University Hospital

Hospital Acquired Infections. Anucha Apisarnthanarak, MD Infectious Disease Division Thammasart University Hospital Hospital Acquired Infections Anucha Apisarnthanarak, MD Infectious Disease Division Thammasart University Hospital Nosocomial Infections (NI) Infections acquired in the hospital May become apparent in

More information

FM - Male, 38YO. MRSA nasal swab (+) Due to positive MRSA nasal swab test, patient will be continued on Vancomycin 1500mg IV q12 for MRSA treatment...

FM - Male, 38YO. MRSA nasal swab (+) Due to positive MRSA nasal swab test, patient will be continued on Vancomycin 1500mg IV q12 for MRSA treatment... Jillian O Keefe Doctor of Pharmacy Candidate 2016 September 15, 2015 FM - Male, 38YO HPI: Previously healthy male presents to ED febrile (102F) and in moderate distress ~2 weeks after getting a tattoo

More information

Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly

Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Wilbur Chen, MD, MS 22-23 March 2017 WHO meeting on Immunization of the Elderly The Problem Increasing consumption

More information

Learning Points. Raymond Blum, M.D. Antimicrobial resistance among gram-negative pathogens is increasing

Learning Points. Raymond Blum, M.D. Antimicrobial resistance among gram-negative pathogens is increasing Raymond Blum, M.D. Learning Points Antimicrobial resistance among gram-negative pathogens is increasing Infection with antimicrobial-resistant pathogens is associated with increased mortality, length of

More information

Public Health Response to Emerging Resistance

Public Health Response to Emerging Resistance National Center for Emerging and Zoonotic Infectious Diseases Public Health Response to Emerging Resistance Alex Kallen, MD, MPH, FACP Lead Antimicrobial Resistance and Emerging Pathogens Team Prevention

More information

Detection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran

Detection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran Letter to the Editor Detection and Quantitation of the Etiologic Agents of Ventilator Associated Pneumonia in Endotracheal Tube Aspirates From Patients in Iran Mohammad Rahbar, PhD; Massoud Hajia, PhD

More information

Multidrug-resistant Organisms (MDROs): Is the Future to be Feared? Multi-drug Resistant Organisms (MDROs)

Multidrug-resistant Organisms (MDROs): Is the Future to be Feared? Multi-drug Resistant Organisms (MDROs) Multidrug-resistant Organisms (MDROs): Is the Future to be Feared? North Carolina Center for Hospital Quality and Patient Safety October 17, 2013 Cary, North Carolina William R. Jarvis, M.D. Jason and

More information

Microbiology. Multi-Drug-Resistant bacteria / MDR: laboratory diagnostics and prevention. Antimicrobial resistance / MDR:

Microbiology. Multi-Drug-Resistant bacteria / MDR: laboratory diagnostics and prevention. Antimicrobial resistance / MDR: Microbiology Multi-Drug-Resistant bacteria / MDR: laboratory diagnostics and prevention June 2017 MeshHp (VS) Medical Care Center Dr. Eberhard & Partner Dortmund (ÜBAG) www.labmed.de MVZ Dr. Eberhard &

More information

Update on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia. Po-Ren Hsueh. National Taiwan University Hospital

Update on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia. Po-Ren Hsueh. National Taiwan University Hospital Update on Resistance and Epidemiology of Nosocomial Respiratory Pathogens in Asia Po-Ren Hsueh National Taiwan University Hospital Ventilator-associated Pneumonia Microbiological Report Sputum from a

More information

Horizontal vs Vertical Infection Control Strategies

Horizontal vs Vertical Infection Control Strategies GUIDE TO INFECTION CONTROL IN THE HOSPITAL Chapter 14 Horizontal vs Vertical Infection Control Strategies Author Salma Abbas, MBBS Michael Stevens, MD, MPH Chapter Editor Shaheen Mehtar, MBBS. FRC Path,

More information

The International Collaborative Conference in Clinical Microbiology & Infectious Diseases

The International Collaborative Conference in Clinical Microbiology & Infectious Diseases The International Collaborative Conference in Clinical Microbiology & Infectious Diseases PLUS: Antimicrobial stewardship in hospitals: Improving outcomes through better education and implementation of

More information

Gram negative bacteraemia

Gram negative bacteraemia Gram negative bacteraemia David Enoch Consultant Medical Microbiologist PHE Cambridge Cambridge University Hospitals NHS FT Overview Gram negative bacteraemia Changing epidemiology in England Epidemiology

More information

Get Smart For Healthcare

Get Smart For Healthcare Get Smart For Healthcare Know When Antibiotics Work Marry Bardin, Quality Improvement Advisor June 9, 2015 Why We Need to Improve In-patient Antibiotic Use Antibiotics are misused in hospitals Antibiotic

More information

Antimicrobial Stewardship/Statewide Antibiogram. Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services

Antimicrobial Stewardship/Statewide Antibiogram. Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services Antimicrobial Stewardship/Statewide Antibiogram Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda CMS and JCAHO

More information

Antibiotic Updates: Part II

Antibiotic Updates: Part II Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures

More information

Collecting and Interpreting Stewardship Data: Breakout Session

Collecting and Interpreting Stewardship Data: Breakout Session Collecting and Interpreting Stewardship Data: Breakout Session Michael S. Calderwood, MD, MPH Regional Hospital Epidemiologist, Dartmouth-Hitchcock Medical Center March 20, 2019 None Disclosures Outline

More information

The importance of infection control in the era of multi drug resistance

The importance of infection control in the era of multi drug resistance Dr. Kumar Consultant Infectious Diseases Physician Hospital Sungai buloh The importance of infection control in the era of multi drug resistance Nosocomial infections In Australian acute hospitals 200,000

More information

ETX0282, a Novel Oral Agent Against Multidrug-Resistant Enterobacteriaceae

ETX0282, a Novel Oral Agent Against Multidrug-Resistant Enterobacteriaceae ETX0282, a Novel Oral Agent Against Multidrug-Resistant Enterobacteriaceae Thomas Durand-Réville 02 June 2017 - ASM Microbe 2017 (Session #113) Disclosures Thomas Durand-Réville: Full-time Employee; Self;

More information

EDUCATIONAL COMMENTARY THE RISE OF CARBAPENEM-RESISTANT ENTEROBACTERIACEAE

EDUCATIONAL COMMENTARY THE RISE OF CARBAPENEM-RESISTANT ENTEROBACTERIACEAE ENTEROBACTERIACEAE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Earn CE Credits under Continuing

More information

CONTAGIOUS COMMENTS Department of Epidemiology

CONTAGIOUS COMMENTS Department of Epidemiology VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007

More information

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland

Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Protocol for Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland Version 1.0 23 December 2011 General enquiries and contact details This is the first version (1.0) of the Protocol

More information

The UK 5-year AMR Strategy - a brief overview - Dr Berit Muller-Pebody National Infection Service Public Health England

The UK 5-year AMR Strategy - a brief overview - Dr Berit Muller-Pebody National Infection Service Public Health England The UK 5-year AMR Strategy - a brief overview - Dr Berit Muller-Pebody National Infection Service Public Health England Chief Medical Officer - Annual Report 2013 Antimicrobial resistance poses catastrophic

More information

Control of Multidrug-resistant Organisms in a Hospital Environment: Multidimensional Approach

Control of Multidrug-resistant Organisms in a Hospital Environment: Multidimensional Approach Control of Multidrug-resistant Organisms in a Hospital Environment: Multidimensional Approach Roy F. Chemaly, MD, MPH, FIDSA, FACP Associate Professor of Medicine Director, Infection Control Director,

More information

Antimicrobial stewardship: Quick, don t just do something! Stand there!

Antimicrobial stewardship: Quick, don t just do something! Stand there! Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger

More information

Two (II) Upon signature

Two (II) Upon signature Page 1/5 SCREENING FOR ANTIBIOTIC RESISTANT ORGANISMS (AROS) IN ACUTE CARE AND LONG TERM CARE Infection Prevention and Control IPC 050 Issuing Authority (sign & date) Office of Administrative Responsibility

More information