Trends In Resistance

Question 1

Which trends of resistance have occurred?

Answer 1

MRSA
VRE
ESBL-GNBs
CPE

Question 2

MRSA

Answer 2

Emerged in 1960s causing a big shock. Now there is MDR-MRSA where they are resistant to fluoquinolones, beta lactams and aminoglycosides and this is found in the majority of HA-MRSA but also found in community.
Trend- decreased throughout the years
Test in the lab= mueller Hinton agar, cefoxitin used instead of methicillin. For 16-20hrs

Question 3

VRE

Answer 3

Emerged in the 1990s
VREs are now also resistant to fluoroquinolones and aminoglycans
Tried to solve the problem via new drugs but now there is resistance
XDR-VRE where they are only susceptible to less than 2 drugs
New drugs must be made to overcome this problem
Trends: Remained high over the years - over 40%. Highest in the EU for the past 8 years and 2nd highest proportion in EU overall (after Cyprus)
Test= via vancomycin and see if any colonies grow within the zone of inhibition or fuzzyness within it

Question 4

ESBL

Answer 4

Emerged in the 1980s
Found in enterobacterales such as E.coli and Klebsiella Pneumonia
Occured to due cross infection and lapse in infection controlled
Trend: Has increased within the 5 years
Test: Cephalosporin and Cephalosporin with beta lactamase inhibitor called clavulanic acid. Resistance= zone of inhibition in the one with only cephalosporin and not zone of inhibition with the inhibitor.

Question 5

CPE

Answer 5

Emerged in the 2000s
They are resistant to beta lactams
Few cases but there is a high carriage rate which can affect healthcare down the line.
Examples include Klebsiella
Very low levels but there is high carriage rates which may infect others.
Trend: In the eu, 13th highest. Most countries have 1% but countries such as Greece have 65% and Spain and Portugal have increasing amounts of resistance.