ESBL and multiresistant bacteria 3.18/5 (11)

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Definition

The definition of multi-resistant bacteria varies. Methicillin-resistant yellow staphylococci (MRSA), vancomycin resistant enterococci (VRE), multiresistant tubercle bacteria (MDRTB) and gram-negative rod bacteria that form broad-spectrum beta lactamases (ESBL / MBL) are the most common. Infections with these bacteria cannot be treated with standard antibiotics. The problem then is that the infections can spread to the individual and also pose a significant infection problem.

  • People with weakened immune systems are particularly at risk. This applies to other people with immunosuppressive rheumatic medication for rheumatic disease

Occurrence

ESBL ("Extended Spectrum Beta-Lactamase") has been found in

  • Klebsiella species
  • E. coli bacteria
  • Gramnegative bowel bacteria that can produce ESBL
  • Different salmonella herb
  • Proteus mirabilis
  • Other Enterobacteriaceae
  • Pseudomonas aeruginosa.

Bacteria that produce ESBL have a significantly higher incidence in some countries, especially in southern Europe (Italy, Greece), Africa and Asia.

Contamination

The bacteria are transmitted from person to person, usually through hands (contact contagion) or through poorly cleaned equipment and common contact points.

Symptoms

Healthy persons (health professionals) are most often without signs of illness (asymptomatic), while infections can develop as a result of reduced immune defenses, such as immunosuppressive anti-rheumatic treatment or severe other illness.

Diagnosis

One takes bacterial samples from wounds or surfaces where bacteria are suspected. Microbiological laboratory conducts resistance determination detects bacteria by culturing or gene-technical methods (PCR).

Treatment

Prevention is very important. Good hand hygiene and use of alcohol-based disinfectants is necessary. Clean wounds with disinfectant. Food is cooked, fruit is peeled. Infections must be treated based on the results of the resistance studies. The Norwegian Institute of Public Health (in Norway) recommends the following (as per 2016): Before or during hospitalization, it is recommended to take samples for ESBL-containing bacteria of all who:

  • Has been hospitalized outside the Nordic region in the last year
  • The last year has been hospitalized in Norway or another Nordic country where there was an outbreak of ESBL-containing bacteria (during the current stay).
  • Have lived together with a person who has detected ESBL-containing bacteria the last year
  • Previously, ESBL-containing bacteria have been detected
  • For all hospitalizations in departments that are classified as departments with particularly susceptible patients and / or high risk of spread (eg fire department, intensive care department, hematology department, newborn infant and similar)

Antibiotics: There are currently only a few groups of beta-lactam antibiotics (the group carbapenems and combination preparations with beta-lactam and betelectamase inhibitor, for example piperacillin-tazobactam), to which ESBL-producing bacteria are sensitive.

Measures in case of individual cases or outbreaks

  • Infected persons should be isolated against contact infection in single rooms with their own toilet
  • No special measures or restrictions are recommended for healthcare professionals who are ESBL-resistant carriers
  • In the event of an outbreak in a health institution, a local working group should be set up to investigate the outbreak and evaluate infection prevention measures. These measures may include: training of staff, patients and relatives, infection detection, isolation of contacts and screening of selected patient groups (but not of staff).

Requirements to report infection

Infectious carriers and infections with microbes with special resistance patterns are reportable disease group A to MSIS. Notification criteria are the detection of

  • Enterobacteriaceae with reduced sensitivity to meropenem and proven ESBLKARBA January
  • Pseudomonas aeruginosa with reduced sensitivity to meropenem and proven ESBLKARBA genes.
  • Acinetobacter spp. With reduced sensitivity to meropenem and proven ESBLKARBA January
  • Enterobacteriaceae, P. aeruginosa, Acinetobacter spp. Isolates with reduced susceptibility to meropenem combined with other phenotypic findings compatible with carbapenemase production, but negative for known ESBLsKARBA genes should be biochemically investigated for carbapenemase production. The finding must be reported to MSIS (Norway) if carbapenemase production is verified in a validated biochemical assay.

Notification to the municipal council, the Norwegian Institute of Public Health and other instances of outbreak or transmission of infected patient between health institutions

Literature


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