Antibiotic-resistance is a major public health problems and has achieved over the last years such proportions as to lead international institutions such as the World Health Organization (World Health Organization, WHO) and the European Centre for Prevention and Disease Control (European Centre for Disease Prevention and Control, ECDC) to launch a serious alarm . Attention was paid in particular to infections caused by some bacterial species such as Enterococcus faecium and Enterococcus faecalis (VRE), Staphylococcus aureus (MRSA), Klebsiella spp. E.coli (ESBL), Acinobacter baumannii, Pseudomonas auruginosa (MDRPA) and Enterobacter (MDR), which have been identified by the acronym ESKAPE. This study focuses on producing enterobacteria carbapenemases, Gram-negative bacteria, which have developed high capacity of resistance to most antibiotics developed in therapy, including carbapenems, considered for years the only choice effective against serious infections caused by these pathogens. The resistance to carbapenems may occur with different mechanisms, but the current emergency concerns especially the transmission of a particular class of enzymes called carbapenemases (KPC), β-lactamase that can inactivate addition carbapenems, including penicillins, cephalosporins, and monobactams. The purpose of this work is to provide practical guidance and operational protocols for the detection, diagnosis, monitoring and controlling the transmission of Enterobacteriaceae producing carbapenemases in health facilities; It was also conducted an epidemiological study, to describe the spatial and temporal distribution of cases of colonization/infection in the light of the results obtained from the laboratory of the Hospital Microbiological SS. Antonio and Margherita di Tortona in the years 2013, 2014 and the first half of 2015; Finally, we evaluated the profile of antibiotic resistance of isolates of K. pneumoniae producing KPC by automated VITEK 2, with further confirmation by phenotypic test (Test of Hodge).
L’antibiotico-resistenza è uno dei principali problemi di Sanità Pubblica e ha raggiunto negli ultimi anni proporzioni tali da indurre istituzioni internazionali, quali l’Organizzazione Mondiale della Sanità (World Health Organization, WHO) e il Centro Europeo per la Prevenzione e il Controllo delle Malattie (European Centre for Disease Prevention and Control, ECDC) a lanciare un serio allarme. L’attenzione è stata rivolta in particolare alle infezioni sostenute da alcune specie batteriche come: Enterococcus faecium e faecalis (VRE), Staphylococcus aureus (MRSA), Klebsiella spp. ed Escherichiacoli (ESBL), Acinobacter baumanii, Pseudomonas auruginosa (MDRPA) ed Enterobacter (MDR), che sono state identificate con l’acronimo di ESKAPE. Questo studio si sofferma sugli enterobatteri produttori di carbapenemasi, batteri Gram-negativi, che hanno sviluppato elevata capacità di resistenza alla maggior parte di antibiotici sviluppati in terapia, tra i quali carbapenemi, considerati da anni l’unica scelta efficace nei confronti delle infezioni gravi causate da questi patogeni. La resistenza ai carbapenemi può avvenire con diversi meccanismi, ma l’emergenza in corso riguarda soprattutto la diffusione di una specifica classe di enzimi chiamati carbapenemasi (KPC), β-lattamasi in grado di inattivare, oltre i carbapenemi, anche le penicilline, cefalosporine e monobattami. Lo scopo di questo lavoro è quello di fornire indicazioni pratiche e protocolli operativi per l’identificazione, la diagnosi, la sorveglianza e il controllo della trasmissione degli enterobatteri produttori di carbapenemasi nelle strutture sanitarie; Inoltre è stato condotto uno studio epidemiologico, per descrivere la distribuzione spaziale e temporale dei casi di colonizzazione/infezione alla luce dei risultati ottenuti dal laboratorio di Analisi Microbiologiche dell’Ospedale SS. Antonio e Margherita di Tortona negli anni 2013, 2014 e nel primo semestre del 2015; infine abbiamo valutato il profilo di resistenza agli antibiotici degli isolati di K. pneumoniae produttori di KPC mediante sistema automatizzato VITEK 2, con ulteriore conferma mediante test fenotipico (Test di Hodge).
Enterobatteri produttori di carbapenemasi: la nuova frontiera dell'antibiotico-resistenza
BAGNARINO, JESSICA
2014/2015
Abstract
Antibiotic-resistance is a major public health problems and has achieved over the last years such proportions as to lead international institutions such as the World Health Organization (World Health Organization, WHO) and the European Centre for Prevention and Disease Control (European Centre for Disease Prevention and Control, ECDC) to launch a serious alarm . Attention was paid in particular to infections caused by some bacterial species such as Enterococcus faecium and Enterococcus faecalis (VRE), Staphylococcus aureus (MRSA), Klebsiella spp. E.coli (ESBL), Acinobacter baumannii, Pseudomonas auruginosa (MDRPA) and Enterobacter (MDR), which have been identified by the acronym ESKAPE. This study focuses on producing enterobacteria carbapenemases, Gram-negative bacteria, which have developed high capacity of resistance to most antibiotics developed in therapy, including carbapenems, considered for years the only choice effective against serious infections caused by these pathogens. The resistance to carbapenems may occur with different mechanisms, but the current emergency concerns especially the transmission of a particular class of enzymes called carbapenemases (KPC), β-lactamase that can inactivate addition carbapenems, including penicillins, cephalosporins, and monobactams. The purpose of this work is to provide practical guidance and operational protocols for the detection, diagnosis, monitoring and controlling the transmission of Enterobacteriaceae producing carbapenemases in health facilities; It was also conducted an epidemiological study, to describe the spatial and temporal distribution of cases of colonization/infection in the light of the results obtained from the laboratory of the Hospital Microbiological SS. Antonio and Margherita di Tortona in the years 2013, 2014 and the first half of 2015; Finally, we evaluated the profile of antibiotic resistance of isolates of K. pneumoniae producing KPC by automated VITEK 2, with further confirmation by phenotypic test (Test of Hodge).È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/21287