Infection prevention and control
Lernkarten zu PACT
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Cartes-fiches
Welche Erreger erzeugen Katheterassoziierte Infekte?
coagulase-negativeStaphylococcus, Staphylococcus aureus, Gram-negative pathogens (e.g. Pseudomonas sp., E. coli),Candida and Enterococcus
Wie behandelt man Katheterinfekte? 3
Breitspektrumantibiotikum: Carbapenem, Tazobac, 3.Gen. Ceph.
+ Antibiotikum gegen SKN-Keime: Vancomycin
+ evtl. Antimykotikum
Welche resistenten gram + Keime? 5
- Methicillin-sensitive Staphylococcus aureus (MSSA)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Coagulase-negative staphylococci
- Enterococcus (a proportion of which are vancomycin-resistant=VRE)
- Clostridium difficile
Welche gram neg. Keime bei nosomomialen Infekten? 6
- Pseudomonas aeruginosa
- Escherichia coli (some of which are extended spectrum beta-lactamase (ESBL)-producing)
- Klebsiella (some of which are ESBL-producing)
- Stenotrophomonas maltophilia
- Enterobacter (may be multi-resistant, including ESBL-producing)
- Acinetobacter
Welche AB wiken gegen Pseudomonaden?
β-lactams with β-lactamase inhibitor combinations (such as piperacillin-tazobactam and ticarcillin-clavulanate) carbapenems (imipenem, meropenem)
cephalosporins (ceftazidime, cefipime)
fluoroquinolones
aminoglycosides
aztreonam
Welche Infekte machen Klebesiellen auf der IPS?
Risikofaktoren? 2
Meist VAP
Lange Hospitalisation
St.n. Antibiotikatherapie
Welche Resistenz entwickeln Klebiellen?
AB?
ESBL
Carbapeneme, manchmal auch Aminoglykoside
Welche Resistenz entwickelt Stenotrophomonas?
AB?
multi-drug resistant (MDR) pathogen-> B-Lactamase aktiv gegen Carbapeneme, Chinolone und Aminoglykoside, Betalaktame
->Cotrimoxazol
Welche Resistenz entwickeln Enterobacter?
AB?
Kommt aus der Familie der Klebsiellen->bildet eine Betalaktamase namens AmpC.
->Carbapenem
Welche Resistenz hat Acinetobacter baumanii?
AB?
Resistent gegen: broad-spectrum cephalosporins, penicillins, fluoroquinolones and aminoglycosides.
This resistance is mediated by plasmid-mediated β-lactamases, chromosomal cephalosporinases, altered penicillin-binding proteins and membrane impermeability.
AB: Carbapenem, Augmentin
Welche Hefen sind häufig auf der IPS?
Welches macht Resistenzen?
Candida Albicans->empf. auf Fluconazol
Candida kruseii und glabrata evtl. resistent->wechsel auf Voriconazol, Amphotericin, Echinocandine
Formen der Resistenzentwicklung bei Erregern? 2
- intrinsic resistance: lack of the molecular target for an antibiotic or membrane impermeability to the agent.
- Acquired resistance is principally due to one of four mechanisms: drug inactivation, reduced permeability, drug efflux or target modification.
Welche Massnahmen reduzieren Katheterassoziierte Infekte?
- Antiseptic handwashing including alcohol rub disinfection
- Full aseptic precautions
- Chlorhexidine 2% skin preparation
- Avoid the femoral route
- Minimise duration of placement
- Empower the nurse to stop unsafe practice