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Staphylococcus aureus Meticilino resistente (MRSA)

Staphylococcus aureus Meticilino resistente (MRSA). Dr. Elio Ochoa Maldonado Infectólogo Plan de seguridad del paciente Programa de prevencion de infecciones Hospital del IESS Guayaquil. 50 años masculino, hernia discal- IQ, cultivo muestra transoperatorio: SAMR.

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Staphylococcus aureus Meticilino resistente (MRSA)

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  1. Staphylococcus aureus Meticilino resistente (MRSA) Dr. Elio Ochoa Maldonado Infectólogo Plan de seguridad del paciente Programa de prevencion de infecciones Hospital del IESS Guayaquil

  2. 50 años masculino, hernia discal- IQ, cultivo muestra transoperatorio: SAMR

  3. 42 años masculino, Trauma Fx tibia – clavo endomedular - IQ, cultivo muestra transoperatorio: SAMR

  4. 35 años masculino, Politraumatismo, SDRA, larga internacion, ARM, cultivo : SAMR

  5. Staphylococcus aureusMeticilino resistente • Primer reporte en 1961 en el Reino Unido • En 1963 se reporta el primer brote en USA • A partir de 1990 se reporta en la comunidad • Cepas comunitarias diferententes a las hospitalarias • En USA: USA300, 400 • Europa: productoras de leucocidinas • Ecuador: PVL

  6. Staphylococcus aureusMeticilino resistente • Mutaciones cromosomicas gen mecA • Suelen presentar otras mutaciones que confieren resistencia a varios antibiot • Alteracion de las PBP, ( sitio diana) • Fatores de virulencia • Adhesion a fibrinogeno, cell • Evasion del sistema inmune • Adhesion alfa toxin, beta gamma delta hemolisinas

  7. Staphylococcus aureusMeticilino resistente • COMUNITARIAS • HOSPITALARIAS

  8. Healthcare-Associated Community-Associated Most Invasive MRSA Infections Are Healthcare-Associated 86% 14% Klevens et al JAMA 2007;298:1763-71

  9. MRSA Strain Characteristics Were Initially Distinct

  10. MRSA Was the Most Commonly Identified Cause of Purulent SSTIs Among Adult ED Patients (EMERGEncy ID Net), August 2004 59% (97% USA300) 54% 39% 15% 55% 74% 51% 68% 60% 60% 72% 67% Moran et al NEJM 2006;355:666-674

  11. COMUNITARIA

  12. Staphylococcus aureus Estrategias de control

  13. Guia IRLANDA 20013

  14. TRATAMIENTO

  15. Neumonía: Linezolide, Vancomicina, ClindamicinaBacteremia:Vancomicina, DaptomicinaPartes blandas: complicada: Vanco, linezolide, dapto, clinda.

  16. Partes blandas: NO complicada: TMS, clinda, Doxiciclina, Minociclina, SNC: Vanco, Line, TMSOsteomielitis: Vanco, Line, TMS, Rifa, Mino, Doxi

  17. TRATAMIENTO BACTEREMIA

  18. TRATAMIENTO BACTEREMIA

  19. Clinical Considerations - Evaluation • MRSA belongs in the differential diagnosis of skin and soft tissue infections (SSTI’s) compatible with S. aureus infection: • Abscesses, pustular lesions, “boils” • “Spider bites” • Cellulitis?

  20. Clinical Considerations - Evaluation • MRSA should also be considered in differential diagnosis of severe disease compatible with S. aureus infection: • Osteomyelitis • Empyema • Necrotizing pneumonia • Septic arthritis • Endocarditis • Sepsis syndrome • Necrotizing fasciitis • Purpura fulminans

  21. NEFROTOXICIDAD MONITOREAR NIVEL SERICO OTROS ANTIMICROBIANOS LINEZOLIDE DAPTO QUINU/DALFO

  22. COLONIZACION

  23. S. aureus Nasal ColonizationNational Health and Nutrition Examination Survey 2001-02 S. aureus: 32.4% = 89.4 M people MRSA: 0.8% = 2.3 M people MRSA colonization associated with age >= 60 years & being female

  24. Staphylococcus aureus

  25. PORTACION TRABAJADOR SALUD

  26. AISLAMIENTO DE CONTACTO

  27. Staphylococcus aureusPrevencion de Infecciones • Precauciones de contacto • Higiene de manos • Baño corporal con clorhexidina • Higiene bucal • Descolonizacion • Monitoreo de personal de salud • Limpieza ambiental • Gestion de antimicrobianos (Stewardship)

  28. SAMR PROGRAMA DE VIGILANCIA ACTIVA

  29. DEBEMOS DESCOLONIZAR LOS TRABAJADORES DE SALUD Y PACIENTES COLONIZADOS ?

  30. GRACIAS

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