genes found on mobile plasmids, which confer resistance to cephalosporin antimicrobials
By what modes of transmission do people get resistant infections? (2)
previously colonized (normal flora, travel to inappropriate location (wound,UT), norml flora give resistance gene to pathogenic organism), nosocomial spread (hospitalized, spread via environment)
How do we become previously colonized? (5)
foodborne, companion animals, occupational exposure, visiting other people with infection/GI colonization, international travel
Humans with pets have a higher rate of _______ colonization.
Role of the hospital environment in transmission of resistant infections? (3)
spread to other patients (nosocomial), colonize ourselves (occupational), spread to owners via their pets (public health)
Solution for prevention and control of resistant infections?
What are the components of antimicrobial stewardship? (6)
correct atb use (culture and sensitivity), appropriate dosing, client education, antimicrobial categories (first choice, reserved, restricted), surveillance, veterinarian education
What types of antibiotics are "reserved"?
What types of antibiotics are "restricted"?
What does the anagram PROTECT stand for?
Types of bacteria and effective drugs
Employ narrow spectrum
Culture and sensitivity
What are 3 microbes that are hazard level urgent?
C. diff, CRE, Neisseria gonorrhoeae
Bacterial mechanisms of resistance. (4)
inactivation or modification of the antibiotic (enzymes), alteration of target binding site, prevent antibiotic accumulation (increased efflux, reduce membrane permeability), modification of the metabolic pathway
Cephalosporins are __________ antimicrobials, which inhibit ___________.
β-lactam; bacterial cell wall synthesis
Veterinary formulated cephalosporin used in food animals and horses.
What genes/mutations confer cephalosporin resistance to bacteria? (2)
chromosomal mutations that reduce cell membrane permeability, transferable β-lactamase genes that enzymatically inactive the drug
What was the first domestically-acquired ceftriaxone-resistant microbe?
Salmonella newport in a child: plasma-encoded AmpC β-lactamase CMY-2: conferred resistance to 1st-3rd generation cephalosporins
What does the CMY-2 gene confer resistance to?
1st, 2nd, and 3rd generation cephalosporins
What is the CMY-2 gene?
plasmid encoded AmpC β-lactamase
What is the CTX-M gene?
plasmid-encoded β-lactamase in gram-negatives- ESBL
What resistance does the CTX-M gene confer?
1st, 3rd, and 4th generation cephalosporins (2nd gen still susceptible)
What 3 species was resistant CTX-M Salmonella recovered from in whatever study that was?
horses, swine, turkeys
What resistance does the NDM gene confer?
all β-lactams including carbapenam, fluoroquinolones, aminoglycosides
What is the NDM gene?
What is the most common mechanism of carbapenam resistance in the US today?
What is the KPC gene?
What resistance does the KPC gene confer?
Carbapenenase-producing organisms have not been isolated from ___________ in the U.S., but they have been isolated from ___________.