12- MRSA and VRE

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What are some issues with VRE (Vancomycin Resistant enterococci)

*may be resistant to other antibiotics too - options vary - not a risk to general population -Colonizes in healthy individuals, who serve as the carriers for VRE -check via rectal swab -life threatening in long-term or compromised patients

MRSA

- Drug resistant bacteria -Methicilisan-resistant staph. aureus -Has ESBL -Resistant to commonly used B-lactam antibiotics

MRSA treatment

- IV vancomycin -New strains show antibiotic resistance even to vancomycin and teicoplanin: vancomycin intermediate-resistant staphylococcus aureus (VISA)

What are some issues found with MRSA?

- It is not a risk to the general population -It colonizes in healthy persons, who serve as the carriers -Can be checked via nasal swab

VRE Treatment

-Can be used with antibiotics other than vancomycin -Lab screening determines which antibiotics are effective Asymptomatic carries= don't usually need treatment -VRE Patients with urinary catheters: remove this when not needed

Name some bacterial cell "targets"

-Cell wall structure/biosynthesis -Protein synthesis -Nucleic acid metabolism -Membrane-active compounds

How is MRSA transmitted?

-Direct and physical person to person contact -Droplet nuclei from the mouth and nose

How is VRE transmitted?

-Direct person to person contact (stool, urine, blood) -not droplet nuclei from the mouth and nose -not usual from causal contact: touching, hugging, etc

VRE

-Drug Resistant bacteria - Vancomycin resistant enterococci -Has ESBL

VISA

-Drug resistant bacteria -Vancomycin intermediate-resistant staph. aureus -Has ESBL

VRE Prevention

-Gloves and gowns -Wash hands thoroughly after bathroom/ contact with VRE persons/substances -Frequently disinfect surfaces

MRSA Prevention

-Gloves and gowns -Wash hands well after using bathroom/ after contact w/ MRSA persons/substances -Frequently disinfect surfaces -Patient screening and isolation (?) -Prophylaxis (?)

Enterococcus

-Isolated from up 25% of healthy persons

What are some antibiotics that target the Cell wall structure/ biosynthesis of the bacteria?

-Natural penicillians -Semi-synthetic penicillians -Cephalosporins -Vancomycin

What is MRSA resistant to?

All B-lactams *Penicillian : - chromosomal mutation -Plasmid: weak B-lactasmase (penicillinase) *Methicillin: due to weak gene cassette -plasmid -borne transposon --> Visa--> van A gene (peptidoglycan change confers the vancomycin resistance)

Antibiotic therapy for CA-MRSA

B-lactam resistant BUT SUSCEPTIBLE to fluoroquinolones, trimethoprim/sulfamethoxazole tetracyclines and macrolides (for now- there are more)

How does PRSP encode antibiotic resistance?

Chromosomal mutation (pen binding protein), no B-lactamase

How does MRSA encode antibiotic resistance?

Chromosomal mutation (peptidoglycan), plamid (B-lactamase)

CA-MRSA

Community Acquired MRSA -"Newer" type, virulent -No co-morbidities -More susceptible to non B-lactam antibiotics= more choices -Serious soft tissue infections -Geneotyps differes from CA-MRSA

ESBL

Extended-spectrum B-lactamases

HA-MRSA

Health Care Associated MRSA -"Older" type -Multiple co-morbidities -Less susceptible to non B-lactam antibiotics --> fewer choices -Fewer serious soft tissue infections -Genotypes differ from CA-MRSA

When is MRSA life threatening?

In patients with.. -deep wounds -IV Catheters, entubations, etc. - secondary infection in immunocompromised patients

How does VISA encode antibiotic resistance?

Plasmid borne transposon (peptidoglycan change)

How does VRE encode antibiotic resistance?

Plasmid borne transposon (peptidoglycan change)

Antibiotic therapy for HA-MRSA

Resistant to B-lactams and -B-lactams, macrolides, fluoroquinolones -Clindamycin and trimethoprim/sulfamethoxazole choices: Vancomycin, teicoplanin, etc.

How many types of MRSA are there?

Two : HA-MRSA and CA-MRSA

Are Enterocci apart of the human flora?

Yes, especially in the -human gastrointestinal tract - especially the colon -female genital tract


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