Wikipedia card Multi-resistant bacteria - E. coli
Multidrug resistant (multiple resistant bacteria) is a multi-drug resistant pathogenic bacteria. Multiresistance can be translated into multi-drug resistance, multiple drug resistance, which is defined as a kind of micro-organisms on the three categories (such as aminoglycosides, erythromycin, B-lactam antibiotics at the same time or more than three types of resistance, rather than the same type of three P-resisitence become pan-resistant strains, almost all classes of antimicrobial resistance, such as pan-resistant Acinetobacter, aminoglycoside, penicillin, resistance to cephalosporins, hydrocarbon enzymes, tetracyclines, fluorine Couinaud ketones and sulfa, etc..
Staphylococcus MDR mostly as opportunistic pathogens, Gram-negative bacilli (GNR) accounted for a large proportion of such as Enterobacteriaceae, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Serratia marcescens, citrate spp, Shigella spp. , Salmonella, and Pseudomonas aeruginosa, Acinetobacter genus, influenza bacillus, gram-positive bacteria methicillin-resistant staphylococci (MRS), in particular MRSA and MRSE, vancomycin-resistant Enterococcus (VRE) in recent years, the incidence in the intensive care unit (ICU) significantly increased the penicillin-resistant Streptococcus pneumoniae (PRSP), a common cause of pneumonia, meningitis, bacteremia, and otitis media, human Mycobacterium tuberculosis bacteria Additionally, there are gonococcal, meningococcal, and Vibrio cholerae.
Mechanism of resistance Multi-drug resistant (multiple resistance, MDR) refers to a variety of commonly used anti-microbial agents, drug resistance, the main mechanism is efflux membrane pump gene mutation, followed by changes in outer membrane permeability and ultra-broad-spectrum enzyme. Up to see a Gram-positive bacteria, MDR-TB and MDR-of MRSA, and often appears in the ICU, Acinetobacter baumannii and Pseudomonas aeruginosa, sensitive only carbapenem; XM Aeromonas almost all of antimicrobial resistance. MDR appears other than cotrimoxazole to determine the combination of the inevitable, the high frequency of MDR strains, means that the anti-microbial agents coming to an end. microbial resistance rates continue to increase mainly due to : irrational use and abuse, 50% for human resistance to infection with agriculture and animal husbandry applications such as the United States, which for the hospital anti-infective and only 20%, and the community accounted for 80% abuse rate of 20 percent to 50 % of therapeutic applications in agriculture and animal husbandry accounted for only 20%, while the prevention and growth-promoting applications accounted for 80% abuse rate of 40 percent to 80 percent, an annual 40 000 deaths caused by drug-resistant. China's abuse is more serious than that of the United States, WHO assessment of the antimicrobial drugs of abuse: 97% of the viral bronchial infection in patients with the use of antimicrobial agents and use of antimicrobial agents, 30% to 60% of patients in primary health care system mechanism of resistance of bacteria to antimicrobial agents can be a variety of the most important for the inactivation of enzymes such as β-lactamases, aminoglycoside passivation enzymes generation, change the target to change, such as penicillin-binding proteins (PBPs) , there are other changes in membrane permeability, drug difficult to enter, bacteria pump out of the system increased, enhanced, in order to discharge the drug has entered the bacteria, as well as membrane active transport to reduce the establishment of a new metabolic pathway, an increase of antagonistic drugs two or more mechanisms can often start. bacterial opportunistic pathogen, often have the opportunity to contact with a variety of antimicrobial agents, so the plasmid within the bacterial cell, chromosome, transposons, integrons, etc. can be resistant accumulation of gene or multiple drug resistance genes, and by combination, transduction and transformation in the different species of bacteria, Gram-positive bacteria and gram-negative bacteria between frequent exchange of resistance gene to obtain longer-term retention of transposable child and integration of the child (as well as smaller DNA fragments) due to the small molecular weight and easily play a leading role in the formation of resistance gene transfer and MDR, under normal circumstances due to chromosome-mediated resistance, the resistant bacteria often with have some defects, while the plasmid-mediated resistant and susceptible strains, can grow and reproduce rapidly. plasmid or chromosome-mediated resistance, generally occurs only in a few bacteria, difficult and sensitive overwhelming competition of bacteria, so its dangers only when susceptible strains of antimicrobial drug selective pressure (selective pressure) a lot of killing, resistant bacteria were able to multiply rapidly and become the dominant bacteria and lead to a variety of infections occurrence of the occurrence and development of drug-resistant and MDR is a widely used antimicrobial agents, in particular, no indications of abuse consequences.
Prevention recommendations The following suggestions may help prevent the growth of MDR and reproduction: a strict management of MDR-infected patients (and carriers), the provision of special rooms, zone isolation, by well-trained allied health professionals infected with the MDR medical care, found that the temporary transfer to another job for the carriers, check each patient must wash your hands of the disinfectant, and need to replace a face mask, white coat or gloves, 4. strict daily ward environment disinfection, the medical staff 'prudent and rational use of antimicrobial drugs' re-education, six at home and abroad unified operational procedures of drug-resistant and MDR monitoring, 7. strict implementation of the management system of the antimicrobial agents, antimicrobial agents there must be a qualified doctor's prescription, vancomycin, broad-spectrum cephalosporins, carbon carbapenem must be approved by the designated medical practitioner s check before dispensing. infectious diseases at home and abroad professionals (including managers) meet on a regular basis , discussion and cooperation. antibacterial drugs in the hospital or regional rotation in stages use may contribute to the susceptible ones to overcome MDR, but need implementation and identification of domestic and foreign areas before they can make a correct judgment of the validity join the Lactobacillus and Bifidobacterium when health care is beyond reproach, but joined the pathogenic potential of Enterococcus genus seems to not be appropriate. low toxicity, the control of MDR-effective new antibacterial drugs since when more developed, but the rational use of existing antibacterial drugs will undoubtedly have important practical significance.
Multi-resistant bacterial infection predictors Against gram-negative bacterial antibiotic choice on clinical outcomes, taking into account the multi-drug resistant (MDR) in ever-increasing, a reasonable choice of antimicrobial treatment to avoid treatment failure is essential. Bochud pointed out that a review of recent For example, early rational use of antimicrobial treatment for patients suffering from gram-negative bacteria, fungus disease and sepsis compared with patients receiving unreasonable treatment of antibiotic treatment can make the overall case fatality rate halved (49% vs. 28% P <0.001). Because the case fatality rate of antimicrobial therapy caused by an irrational and even produced ESBL bacteria in patients with high fatality, which is about 30% to 80%. who have risk factors for infection by gram-negative resistant to help doctors differentiate between patients with drug-resistant pathogens and drug-resistant patients, review the following projections for the standard (prediction the rules). predictive criteria related to the care of gram-negative rod infection is often caused by drug-resistant Enterobacteriaceae, unless carried out there are too invasive operation, or non-fermentative bacteria cause infection is unlikely. the use of fluoroquinolones and fluoroquinolone-resistant closely related to predictive criteria in the use of certain antibiotics, infection, suggesting that there may be of this drug The meaning of resistance, and also increased the possibility of all the joint drug of choice (co-selected agents) resistance of multi-drug resistant (MDR) in the joint selection (co-selection) to penicillin, cephalosporins aminoglycosides, sulfonamides different azoles or quinolone resistance exist. Given these projections standard, the degree of contact between the evaluation of patients and health care institutions, the history of early antibiotic treatment, and patient characteristics, a drug-resistant pathogens risk stratification system. 'Multiple drug-resistant'