Multiresistente Erreger – Prävention und Diagnostik

Zusammenfassung

Multiresistente Keime spielen im klinischen Alltag eine zunehmend bedeutsame Rolle. Dieses besonders auf Intensivstationen bzw. in Risikobereichen. Oftmals herrschen Unklarheiten bezüglich diagnostischer Screening-Indikationen und Strategien zur Vermeidung von Übertragungen mittels Hygiene- und Isolierungsmaßnahmen. Wir geben einen orientierenden Überblick über die zur Zeit gängigen Empfehlungen und bewerten diese für Methicillin-resistente Staphylococcusaureus-Stämme (MRSA) und multiresistente gramnegative Bakterien (MRGN).

Abstract

Multiresistant bacteria play an increasingly important role in everyday clinical practice. This is particularly the case in intensive care units and wards with critically ill patients. Often there is insufficient knowledge concerning diagnostic screening indications and strategies to avoid cross-transmission via infection control strategies. Hereby, we provide an orienting overview and assessment about current guidelines and recommendations with special focus on methicillin-resistant Staphylococcus aureus (MRSA) and multiresistantgramnegative bacteria (MRGN).

Schlüsselwörter:

Multiresistente Keime - MRSA - MRGN - Screening

Key words:

multiresistant bacteria - MRSA - MRGN - diagnostic screening

• Literatur

• 1 Chen LF. The changing epidemiology of methicillin-resistant Staphylococcus aureus: 50 years of a superbug. Am J Infect Control 2013; 41: 448-451
• 2 2010 G. Antibiotika-Resistenz und -Verbrauch (2010) Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Bundesamt für Verbraucherschutz und Lebensmittelsicherheit. Paul-Ehrlich-Gesellschaft für Chemotherapie e.V., Infektiologie Freiburg. AntiinfectivesIntelligence Gesellschaft für klinisch-mikrobiologische Forschung und Kommunikation mbH.
• 3 RKI. Eigenschaften, Häufigkeit und Verbreitung von MRSA in Deutschland – Update 2013/2014. Epidemiologisches Bulletin 2015; 31: 304-304
• 4 KISS. http://www.nrz-hygiene.de/fileadmin/nrz/module/mrsa/MRSA_Referenzdaten_2014.pdf. In
• 5 Engemann JJ, Carmeli Y, Cosgrove SE et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36: 592-598
• 6 Cameron DR, Howden BP, Peleg AY. The interface between antibiotic resistance and virulence in Staphylococcus aureus and its impact upon clinical outcomes. Clin Infect Dis 2011; 53: 576-582
• 7 Yaw LK, Robinson JO, Ho KM. A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis 2014; 14: 967-975
• 8 Bode LG, Kluytmans JA, Wertheim HF et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. The New England journal of medicine 2010; 362: 9-17
• 9 Fätkenheuer G, Kaasch AJ. How deadly is methicillin-resistant Staphylococcus aureus?. Lancet Infect Dis 2014; 14: 905-907
• 10 Huang SS, Septimus E, Kleinman K et al. Targeted versus universal decolonization to prevent ICU infection. The New England journal of medicine 2013; 368: 2255-2265
• 11 van Belkum A, Verkaik NJ, de Vogel CP et al. Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis 2009; 199: 1820-1826
• 12 Williams RE. Healthy carriage of Staphylococcus aureus: its prevalence and importance. BacteriolRev 1963; 27: 56-71
• 13 RKI. Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcusaureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Epidemiologisches Bulletin 2014; 57: 696-732
• 14 Tacconelli E, De Angelis G, de Waure C et al. Rapid screening tests for methicillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. Lancet Infect Dis 2009; 9: 546-554
• 15 Farbman L, Avni T, Rubinovitch B et al. Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review. ClinMicrobiol Infect 2013; 19: 582-593
• 16 McKinnell JA, Huang SS, Eells SJ et al. Quantifying the impact of extranasal testing of body sites for methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission. Infect Control HospEpidemiol 2013; 34: 161-170
• 17 Daeschlein G, Assadian O, Daxboeck F et al. Multiplex PCR-ELISA for direct detection of MRSA in nasal swabs advantageous for rapid identification of non-MRSA carriers. Eur J ClinMicrobiolInfect Dis 2006; 25: 328-330
• 18 Holfelder M, Eigner U, Turnwald AM et al. Direct detection of methicillin-resistant Staphylococcus aureus in clinical specimens by a nucleic acid-based hybridisation assay. ClinMicrobiol Infect 2006; 12: 1163-1167
• 19 Gastmeier P, Schwab F, Geffers C et al. To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infect Control HospEpidemiol 2004; 25: 109-113
• 20 Harbarth S, Masuet-Aumatell C, Schrenzel J et al. Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006; 10
• 21 Sroka S, Gastmeier P, Meyer E. Impact of alcohol hand-rub use on meticillin-resistant Staphylococcus aureus: an analysis of the literature. J Hosp Infect 2010; 74: 204-211
• 22 Siegel JD, Rhinehart E, Jackson M et al. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35: 65-164
• 23 Derde LP, Dautzenberg MJ, Bonten MJ. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med 2012; 38: 931-939
• 24 Ridenour G, Lampen R, Federspiel J et al. Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control HospEpidemiol 2007; 28: 1155-1161
• 25 Sandri AM, Dalarosa MG, Ruschel de Alcantara L et al. Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and chlorhexidine baths for nasal carriers of MRSA. Infect Control HospEpidemiol 2006; 27: 185-187
• 26 Ammerlaan HS, Kluytmans JA, Wertheim HF et al. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. ClinInfect Dis 2009; 48: 922-930
• 27 Vasquez JE, Walker ES, Franzus BW et al. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital. Infect Control HospEpidemiol 2000; 21: 459-464
• 28 Harbarth S, Liassine N, Dharan S et al. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000; 31: 1380-1385
• 29 Kola A, Gastmeier P. Efficacy of oral chlorhexidine in preventing lower respiratory tract infections. Meta-analysis of randomized controlled trials. J Hosp Infect 2007; 66: 207-216
• 30 Clavero J, Baca P, Junco P et al. Effects of 0.2% chlorhexidine spray applied once or twice daily on plaque accumulation and gingival inflammation in a geriatric population. Journal of clinical periodontology 2003; 30: 773-777
• 31 Russotto V, Cortegiani A, Graziano G et al. Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria. Infect Drug Resist 2015; 8: 287-296
• 32 RKI. Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Epidemiologisches Bulletin 2012; 55: 1354-1354
• 33 RKI. Ergänzung zu den "Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen" (2012) im Rahmen der Anpassung an die epidemiologische Situation. Epidemiologisches Bulletin 2014; 21: 183-184
• 34 Tacconelli E, Cataldo MA, Dancer SJ et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. ClinMicrobiol Infect 2014; 20 (Suppl. 01) 1-55
• 35 Katsandri A, Avlamis A, Vasilakopoulou A et al. Risk factors for coexistence of fluoroquinolone resistance and ESBL production among Enterobacteriaceae in a Greek university hospital. J Chemother 2008; 20: 452-457
• 36 Walsh F, Rogers TR. Comparison of plasmid-mediated quinolone resistance and extended-spectrum beta-lactamases in third-generation cephalosporin-resistant Enterobacteriaceae from four Irish hospitals. J Med Microbiol 2012; 61: 142-147
• 37 Witte WM. β-Laktamasen mit breitem Wirkungsspektrum. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2003; 46: 881-890
• 38 Pages JM, James CE, Winterhalter M. The porin and the permeating antibiotic: a selective diffusion barrier in Gram-negative bacteria. Nature reviews Microbiology 2008; 6: 893-903
• 39 Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clinical microbiology reviews table of contents 2007; 20
• 40 Wiener-Well Y, Rudensky B, Yinnon AM et al. Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak. J Hosp Infect 2010; 74: 344-349
• 41 Calfee D, Jenkins SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control HospEpidemiol 2008; 29: 966-968
• 42 Doi Y, Onuoha EO, Adams-Haduch JM et al. Screening for Acinetobacter baumannii colonization by use of sponges. J ClinMicrobiol 2011; 49: 154-158
• 43 Johnson PD, Martin R, Burrell LJ et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005; 183: 509-514
• 44 Borer A, Gilad J, Porat N et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect 2007; 67: 149-155
• 45 Huttner B, Haustein T, Uckay I et al. Decolonization of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae with oral colistin and neomycin: a randomized, double-blind, placebo-controlled trial. J AntimicrobChemother 2013; 68: 2375-2382
• 46 Saidel-Odes L, Polachek H, Peled N et al. A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage. Infect Control HospEpidemiol 2012; 33: 14-19
• 47 Strenger V, Gschliesser T, Grisold A et al. Orally administered colistin leads to colistin-resistant intestinal flora and fails to prevent faecalcolonisation with extended-spectrum beta-lactamase-producing enterobacteria in hospitalised newborns. Int JAntimicrob Agents 2011; 37: 67-69
• 48 Kola A, Holst M, Chaberny IF et al. Surveillance of extended-spectrum beta-lactamase-producing bacteria and routine use of contact isolation: experience from a three-year period. J Hosp Infect 2007; 66: 46-51
• 49 Climo MW, Yokoe DS, Warren DK et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. The New England journal of medicine 2013; 368: 533-542
• 50 Morgan DJ, Pineles L, Shardell M et al. Effect of chlorhexidine bathing and other infection control practices on the Benefits of Universal Glove and Gown (BUGG) trial: a subgroup analysis. Infect Control HospEpidemiol 2015; 36: 734-737
• 51 Viray MA, Morley JC, Coopersmith CM et al. Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection. Infect Control HospEpidemiol 2014; 35: 243-250
• 52 Cassir N, Thomas G, Hraiech S et al. Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria. Am J Infect Control 2015; 43: 640-643
• 53 Cassir N, Papazian L, Fournier PE et al. Insights into bacterial colonization of intensive care patients' skin: the effect of chlorhexidine daily bathing. Eur J ClinMicrobiol Infect Dis 2015; 34: 999-1004