Multi-drug resistant pathogens. Helmut Albrecht, MD Division of Infectious Diseases. Disclosures. Grant/Research Support–MSD, J&J, VIIF, Gilead (no payment to me) Consultant–France Foundation (non profit project with Duke), VIIF, Gilead (no honoraria) Speaker’s Bureau–(no honoraria). Agenda.
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Helmut Albrecht, MD
Division of Infectious Diseases
It is a lot more difficult to get it right if the bacteria are multi-drug resistant
Adapted from Livermore and Woodford, Trends in Microbiol, 2006.
19 Months ESBL Klebsiella pneumoniae Outbreak New York Hospital Medical Center of Queens
Meyer et al. Ann. Int. Med. 119: 353-358 1993
Substrate Profile Hospital Medical Center of Queens
Most Klebsiella infections are easy to deal with, but some are worse than others
Because the host is bad?!
Because the bug is bad?!
Because the drugs are bad?!
Drugs with Most Reliable Activity Against Hospital Medical Center of Queens
Geographical Distribution of KPC-Producers Hospital Medical Center of Queens
Inter-Institutional & Inter-State Spread of KPC-Producing Hospital Medical Center of QueensK. pneumoniae
< 10% susceptible to usual Rx
>40% resistant to tigecycline, >90% susceptible to colistin
Procedure described by Lee et al. CMI, 7, 88-102. 2001.
Lawn of E. coli ATCC 25922
1:10 dilution of a
0.5 McFarland suspension
Described by Lee et al. CMI, 7, 88-102. 2001.
Grayson et al, AAC
Children distinguished from hospital acquired strains by the presence of:
HomelessPopulations with ca-MRSA
Clinically Relevant CA-MRSA Disease distinguished from hospital acquired strains by the presence of:(GA/MD/MN n=1,674, 78%)
Fridkin et al. NEJM, 2005
déjà vu II distinguished from hospital acquired strains by the presence of:
Okuma et al. J Clin Micro 2002 distinguished from hospital acquired strains by the presence of:
Vandenesch et al. EID Aug 2003
Lack of association distinguished from hospital acquired strains by the presence of:
of resistance with a
Favors clonal or
Amenable to strict
infection control procedures
significant reduction in
resistance occursStrategies for Managing Outbreaks of Resistance
Ahmad M et al. Clin Infect Dis 1999;29:352-355
Synergy vs. antagonism distinguished from hospital acquired strains by the presence of:
1 + 1 = 3 vs. 1 + 1 = 0