Epidemiologicky závažné patogény na prahu postantibiotickej éry J A N U Á R
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1 Epidemiologicky závažné patogény na prahu postantibiotickej éry Š T E F K O V I Č O V Á M. K O P I L E C G A R A B Á Š O V Á M. L I T V O V Á S. V I I I. S L O V E N S K Ý V A K C I N O L O G I C K Ý K O N G R E S J A N U Á R
2 Vlastnosti epid. závažných patogénov kontagiozita rýchle šírenie v nemocnici virulencia závažné klinické priebehy a smrtnosťou epidemické vzplania rezistencia sú rezistentné k prvej línii terapie alebo majú nezvyčajný typ rezistencie, ťažko liečiteľné infekcie novo objavený alebo reemerging patogén
3 Definície rezistentných kmeňov MDR (multirezistentné) necitlivosť najmenej na 1 ATB v 3 a viac skupinách XDR (extrémne rezistentné) necitlivosť najmenej na 1 ATB vo všetkých okrem 2 a menej skupin bakteriálny kmeň je citlivý iba na 1 alebo 2 skupiny PDR (panrezistentné) necitlivosť na všetky ATB vo všetkých skupinách
4 skupinách XDR PDR Zdroj:Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrugresistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;78(3):
5 Vývoj ATB a rozvoj rezistencie - v priemere 8 rokov Zdroj: Public Health England, 2015, Silver, L., 2011
6 Najzávažnejšie patogény v nemocničnom prostredí CPE Karbapeném rezistentné Enterobacteriaceae KRAB Karbapeném rezistentný Acinetobacter baumanii VRE - Vankomycín - rezistentný Enterococcus MDR Pseudomonas aeruginosa ESBL Enterobacteriaceae MRSA Flukonazol rezistentné Candida Clostridium difficile...
7 Staphylococcus aureus: % invazívnych izolátov rezistentných na meticillin (MRSA); EU/EEA, MRSA v SR ,8 16,3 21,7 26,6 Zdroj: EARS-Net, 2016
8 Clostridium difficile toxinogénne kmene Clostridium difficile najmä vysoko virulentné ribotypy majú obrovský epidemický potenciál (BI/NAP1/027) - zvýšenie incidencie, závažnosti a mortality CDI cca. 20% pacientov má minimálne 1 rekurenciu (1) Spóry CD pretrvávajú v izbe pacienta aj pol roka možnosť nákazy dlho po prepustení pacienta Zdroj: (1) Dubberke ER, Olsen MA. Clin Infect Dis. 2012, 55 (suppl 2): S88-92
9 Clostridium difficile 1978 Identifikácia toxínov C. difficile 1990 záznamy o globálnom výskyte Incidencie Incidencie mortality Zdroj: Kelly - LaMont. In N Engl J Med 2008, vol. 359, p:
10 MDR gramnegatívne baktérie výskyt tzv. superrezistentných baktérií (tzv. superbugs ) alebo extenzívne rezistentných mikroorganizmov (X-DR) Pseudomonas aeruginosa, Acinetobacter baumanii, Klebsiella spp., Enterobacter, spp. a ďalšie Enterobacteriaceae, sú nositeľmi génov produkujúcich metalobetalaktamázy v Taliansku VIM-1 (Verona imipenemase) v Brazílii SPM (Sao Paulo metallo) v Kórei SIM (Seoul imipenemase) v Austrálii AIM (Australia imipenemase) v Holandsku DIM-1 (Dutch imipenemase) Zdroj: Krčméry, V. In Via practica. 2011; 8 (1)
11 Enterobacteriaceae produkujúce metalo-betalaktamázy rezistentné na všetky cefalosporíny a penicilíny, na všetky chinolóny a aminoglykozidy, aj na tzv. rezervné ATB od r. 09/2009 diseminácia týchto mikróbov z južnej Ázie nesú na plazmidoch gén, podobný VIM a SIM gén NDM-1 (New Delhi metalobetalactamase 1) kódujúci rezistenciu aj na posledné rezervné ATB karbapenémy (Meropenem) šírenie aj do krajín s najnižšou ATB rezistenciou Švédsko, Holandsko, Anglicko
12 Šírenie KPC 2000: Analýza 1996 vzoriek z nemocnice v Severnej Karolíne našla Klebsiella pneumoniae nesúcu gén nazývaný KPC ktorý udáva rezistenciu ku karbapenémom 2003: KPC rýchle šírenie medzi nemocnicami v New York City. Od roku % Klebsiella v meste je nositeľom génu rezistencie. 2005: KPC rozšírenie z New Yorku do dalších krajín, zahŕňajúc Izrael. Z Izraela cestovaním do Talianska, Kolumbie, Veľkej Británie a Švédska. 2008: Vo Švédsku sa našiel nový gén karbapenémovej rezistencie, NDM Zdroj: McKenna, M., 2013
13 Zdroj: EARS-Net, 2016 Klebsiella pneumoniae: percento invazívnych izolátov rezistentých na karbapenémy EU/EEA, 2015
14 Rezistencia KPC K. pneumoniae na kolistín Kolistín (polymyxín E) - objavený pred viac ako 60 rokmi = kľúčova zložka kombinácie antimikrobiálnych režimov používaných na liečbu ťažkých infekcií KPC - K. pneumoniae globálne šírenie KPC- K. pneumoniae hlásená rezistencia na kolistín (Taliansko 1, USA 2, Grécko 3, Maďarsko 4, Turecko 5) Údaje zhromaždené z 21 nemocničných laboratórií v Taliansku v rokoch 2013/2014 poukázali, že 6 : 43% z KPC - K. pneumoniae boli rezistentné na kolistín zvyšujúci sa výskyt rezistencie KPC K. pneumoniae na kolistín = hrozba pre verejné zdravie Zdroj: 1)Cannatelli et al, 2014, Giani et al, 2015, 2)Bogdanov et al., 2011, 3)Kontopoulou et al., 2010, 4)Toth et al., 2010, 5) Labarca et al., 2014, 6) Monaco, M., et al. 2014
15 budú nozokomiálne vakcíny patriť do arzenálu nástrojov pre boj s nozokomiálnymi patogénmi? akú úlohu zohrajú ďalšie profylaktické imunitné zásahy, ako sú monoklonálne protilátky,...?
16 ĎAKUJEM ZA POZORNOSŤ
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