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    ESKAPE Pathogen & Antibiogram

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    vijayasree bavireddy
    This document discusses the ESKAPE pathogens and antibiotic resistance patterns seen in a hospital. It finds that Escherichia coli was the most commonly isolated pathogen followed by Klebsiella pneumoniae and Acinetobacter baumannii. Resistance to carbapenems is high in Acinetobacter baumannii at 87.5%. Susceptibility to major antipseudomonal drugs is decreasing in Pseudomonas aeruginosa. MRSA rates are increasing annually. Vancomycin resistance in enterococci was seen in 14.9% of isolates, with higher rates in Enterococcus faecium. The increasing antimicrobial resistance seen in these pathogens poses a serious threat.

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    ESKAPE Pathogen & Antibiogram

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    vijayasree bavireddy
    58 views33 pages
    This document discusses the ESKAPE pathogens and antibiotic resistance patterns seen in a hospital. It finds that Escherichia coli was the most commonly isolated pathogen followed by Klebsiella pneumoniae and Acinetobacter baumannii. Resistance to carbapenems is high in Acinetobacter baumannii at 87.5%. Susceptibility to major antipseudomonal drugs is decreasing in Pseudomonas aeruginosa. MRSA rates are increasing annually. Vancomycin resistance in enterococci was seen in 14.9% of isolates, with higher rates in Enterococcus faecium. The increasing antimicrobial resistance seen in these pathogens poses a serious threat.

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    ESKAPE pathogen & Antibiogram

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    This document discusses the ESKAPE pathogens and antibiotic resistance patterns seen in a hospital. It finds that Escherichia coli was the most commonly isolated pathogen followed by Klebsiella pneumoniae and Acinetobacter baumannii. Resistance to carbapenems is high in Acinetobacter baumannii at 87.5%. Susceptibility to major antipseudomonal drugs is decreasing in Pseudomonas aeruginosa. MRSA rates are increasing annually. Vancomycin resistance in enterococci was seen in 14.9% of isolates, with higher rates in Enterococcus faecium. The increasing antimicrobial resistance seen in these pathogens poses a serious threat.

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    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    58 views33 pages

    ESKAPE Pathogen & Antibiogram

    Uploaded by

    vijayasree bavireddy
    This document discusses the ESKAPE pathogens and antibiotic resistance patterns seen in a hospital. It finds that Escherichia coli was the most commonly isolated pathogen followed by Klebsiella pneumoniae and Acinetobacter baumannii. Resistance to carbapenems is high in Acinetobacter baumannii at 87.5%. Susceptibility to major antipseudomonal drugs is decreasing in Pseudomonas aeruginosa. MRSA rates are increasing annually. Vancomycin resistance in enterococci was seen in 14.9% of isolates, with higher rates in Enterococcus faecium. The increasing antimicrobial resistance seen in these pathogens poses a serious threat.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33

    ESKAPE pathogens

    &
    Antibiogram

    Dr. Sreekumary P.K.


    Professor & Head
    Department of Microbiology
    Government medical college Kottayam
    E-mail: [email protected]
    ESKAPE
    E - Enterococcus faecium
    S - Staphylococcus aureus
    K - Klebsiella pneumoniae
    A - Acinetobacter baumannii
    P - Pseudomonas aeruginosa
    E - Enterobacter species
    ESKAPES

    • Stenotrophomons maltophilia

    • Escherichia coli
    Infections - ESKAPE
    • Health – care associated pneumonia

    • Urinary tract infections

    • Wound & skin infections

    • Infection in the site of surgery

    • Bacteremia & endocarditis


    1. Enterococcus faecium

    • Gram - positive cocci


    • Present in gastrointestinal tract of human
    • Develop biofilm – medical device associated infections
    • Vancomycin – resistant strains of E. faecium

    • VRE - major cause of device associated infections


    Catheter – associated UTIs
    Surgical wound infections
    Blood stream infections
    2. Staphylococcus aureus
    • Gram positive cocci

    • Most abundant normal flora of the skin & nasal cavity

    • Opportunistic pathogen – skin infections


    bacteremia & sepsis
    RTIs
    • Biofilm formation – majority of HCAIs worldwide

    • Serious threat in hospital settings – increase mortality


    Methicillin- resistant Staphylococcus aureus (MRSA)

    • Superbug – Skin & soft tissue infections


    UTIs
    Sepsis
    • 50 % of Staphylococcal infections
    3.Klebsiella pneumoniae
    • Gram – negative rod belongs to family Enterobacteriaceae
    • Human body - in low numbers
    • Most common pathogen Bacterial
    pneumonia in patients on ventilators & ICUs
    UTIs
    Catheter –associated infections Surgical
    wound infections

    • Carbapenem – Resistant K. pneumoniae ( CRKP ) :


    urgent threat list
    4. Acinetobacter baumannii
    • Gram negative Cocco-bacilli

    • Normally found in soil & water

    • Transient flora in human skin

    • RTIs , UTIs , wound infections

    • Carbapenem Resistant A . baumannii (CRAB)


    Ventilator associated pneumonia
    5. Pseudomonas aeruginosa
    • Non - fermenting Gram - negative rod
    • Opportunistic pathogen
    • Hospitalised patients especially with impaired immune
    function
    Hospitalised – Acquired pneumonia
    Blood stream infection
    UTIs – 30 to 40 %
    of all HCAI
    Wound infection - burns unit
    Pseudomonas aeruginosa - contd

    • Multidrug- resistant strains of P. aeruginosa -


    increasing globally - mortality rate up to 60%
    Intrinsically resistant to many antimicrobial agents

    • Listed under serious threat list of CDC


    6. Enterobacter species
    • Gram negative lactose fermenting rod
    • Recent surveillance –
    2nd /3rd most common Enterobacteriaceae spp
    associated with Carbapenemases (NDM in India)
    • Enterobacter aerogenes : E. cloacae , E. sakazakii
    • Common - UTIS & RTIS
    • MDR spp – resistant to beta- lactams & Cephalosporins

    hard to treatment
    Mechanism of resistance in ESKAPE
    pathogens

    • Antimicrobial inactivation/ Alteration


    production of enzymes that irreversibly destroy or
    modify the antimicrobial molecules resulting in their
    inactivation/ alternation
    GNB – Pseudomonas
    , Acinetobacter
    Klebsiella
    Enterobacter
    Mechanism of resistance in ESKAPE pathogens - contd

     β –Lactamases
    main mechanism in GNB ESKAPE pathogen
    resistance against lactam antibiotics by hydrolyzing
    β lactam ring of antibiotics

    Clinically important BL produced by ESKAPE pathogen :


    Extended spectrum β -
    Lactamases (ESBLs) Amp C β
    Lactamases (ABLs)
    Carbapenamases
    Metallo-β Lactamases
    Mechanism of resistance in ESKAPE pathogens - contd

     Aminoglycoside Modifying Enzymes (AMEs)


    resistant against aminoglycoside
    reduce affinity to bind with bacterial ribosomes
    escape from the actions of AK , Tobra , Neomycin & Genta

    Aminoglycoside acetyl transferase (AACs) –


    main Aminoglycoside phosphor transferases (APHs)
    Aminoglcoside nucleotidyl tranferases (ANTs)
    Mechanism of resistance in ESKAPE pathogens - contd
    • Antimicrobial ’s Target Modification reduces
    affinity to bind with bacterial component

    modification of target enzymes/protein :


    Penicillin binding proteins - β –Lactam
    DNA gyrase & Topoisomerase IV – quinoline & fluroquinolones

    modification of ribosomal target sites :


    methylation of A2058 residue of 23S r RNA of 50S ribosome resistance against
    macrolides eg:- S.aureus & Enterococcus spp
    methylation of A2503 residue of 23S r RNA of 50S ribosome resistance to
    Linezolid (S. aureus & Enterococcus spp) methylation of 16S r
    RNA residue decreases affinity of aminoglycoside binding to the bacterial
    ribosome

    modification in Cell-wall Precursors :


    provides resistance against glycopeptides to gram positive ESKAPE pathogen
    Mechanism of resistance in ESKAPE pathogens - contd

    • Modification in membrane permeability


    reduction in uptake of antibiotics – low intracellular
    concentration of
    antibiotics Reduce
    membrane permeability :
    modification in porins
    down regulation
    loss of porins channels in outer membrane

    eg : resistance to β-Lactam & fluroquinolones


    Mechanism of resistance in ESKAPE pathogens - contd

    • Efflux pumps : extrude intracellular antibiotics


    six classes of efflux pumps – present in ESKAPE

    Resistance nodular division (RND) : MDR in GNB in ESKAPE


    P.aeroginosa & A. baumannii
    Aminoglycosides ,Fluroquinolones
    Carbapenems
    Major facilitator superfamily (MSF)
    Multidrug and toxic compound extrusion (MATE)
    ATP-binding cassette(ABC)
    Proteobacterial
    antimicrobial compound efflux (PACE)

    AcrAB efflux pump –


    Imi, Tetre , Chlor , Fluro resistance in
    Mechanism of resistance in ESKAPE pathogens - contd

    • Biofilm formation by ESKAPE


    S. aureus P.
    aeruginosa A. baumannii
    K. pneumoniae

    increases chance of survival in


    medical devices
    provides resistance to antibiotics :
    restricting antibiotic penetration
    modifying antibiotics
    increasing interaction between different bacterial spp
    upregulating effluxes
    enhancing horizontal gene transfer
    ENTEROCOCCUS
    ACINETOBACTER
    • RESISTANCE
    •
    • Highlights of data 2021:
    ● Escherichia coli was the most commonly isolated pathogen followed by the
    Klebsiella pneumoniae
    Acinetobacter baumannii
    Pseudomonas
    aeruginosa
    Staphylococcus aureus.
    ● Imipenem susceptibility of
    E. coli has dropped steadily from 86% in 2016 to 64% in 2021
    Klebsiella pneumoniae dropped steadily from 65% in 2016
    45% in 2020
    43% in 2021.
    ● Resistance to carbapenems in Acinetobacter baumannii was recorded as 87.5%
    ● In Pseudomonas aeruginosa, more than 60% susceptibility was
    observed for various aminoglycosides and fluoroquinolones in 2021.
    There is a consistent increase insusceptibility to all the
    major antipseudomonal drugs in the last few
    years.
    ● In Staphylococcus aureus:
    MRSA rates are increasing each year from 2016 to 2021
    (28.4% to 42.6%).
    The anti MRSA antibiotics such as vancomycin and daptomycin showed
    excellent in vitro activity (100% against MRSA isolates).
    Linezolid resistance was encountered in both MRSA and CoNS
    isolates at very low rates of 0.1%.
    ● Vancomycin resistance in enterococci (E. faecalis and E. faecium)
    was 14.9%,
    the rate was 6 times higher in E. faecium compared to E. faecalis

    37.5% of Enterococcus faecium causing blood stream infections


    (BSIs) were Vancomycin
    resistant.
    THANK
    YOU

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