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The Rise of Carbapenem Resistant Organisms RUSI/STFC workshop on Antimicrobial Resistance 6 th February 2013 Professor Mike Sharland Professor of Paediatric.

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Presentation on theme: "The Rise of Carbapenem Resistant Organisms RUSI/STFC workshop on Antimicrobial Resistance 6 th February 2013 Professor Mike Sharland Professor of Paediatric."— Presentation transcript:

1 The Rise of Carbapenem Resistant Organisms RUSI/STFC workshop on Antimicrobial Resistance 6 th February 2013 Professor Mike Sharland Professor of Paediatric Infectious Diseases St George’s, University of London Chair of the DH advisory committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI)

2 Carbapenem Resistant Organisms (CRO’s) Extremely Resistant Gram Negative Bacteria Extremely Resistant Gram Negative Bacteria Complex names – KPC, NDM, VIM, OXA – enzymes and bacteria Complex names – KPC, NDM, VIM, OXA – enzymes and bacteria Rapid global Spread Rapid global Spread Resistant to last decent antibiotic class – carbapenems (meropenem) Resistant to last decent antibiotic class – carbapenems (meropenem) With inadequate treatment can become pan-resistant With inadequate treatment can become pan-resistant

3 CRO – Serious Adverse Outcomes Mortality 20-40% - associated with: Extended Hospital Stay Extended Hospital Stay –Esp ICU Exposure to Invasive Devices Exposure to Invasive Devices –E.g. Ventilators, Central Venous Catheters Comorbidities assoc with Advanced Age Comorbidities assoc with Advanced Age –E.g. immunosupression, cardiac disease, chronic airway disease – also premature

4 4 Worldwide Distribution of Klebsiella pneumoniae carbapenemase producers Kumarasamy et al., Lancet Infect Dis :

5 Johnson and Woodford J Med Micro 2013; doi: /jmm Spread of NDM-Mediated Carbapenem Resistance

6 6 Klebsiella pneumoniae: percentage of invasive isolates with resistance to carbapenems

7 7 Giani et al – JCM 2009 Rossolini GM – unpublished Fontana et al – BMC Res Notes 2010 Marchese et al – J Chemother 2010 Ambretti et al – New Microb 2010 Gaibani et al – Eurosurv 2011 Mezzatesta et al – CMI 2011 Agodi et al – JCM 2011 Richter et al – JCM 2011 Di Carlo et al – BMC Gastroenterol 2011 Rossolini GM – unpublished late 2008 The first reported cases of KPC-Kp (ST258) KPC-producing K. pneumoniae - Italian experience early 2011 AMCLI – CoSA CRE network Frasson et al – JCM 2012 ARISS-CoSA study – unpublished ST258, ST512 (CC258) ST512 ST258 ST101 ST15 ST147-like late 2012

8 Carbapenen-resistant K. pneumoniae AMCLI-CoSA – Italian National CRE Surveillance 2011

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10 Israel’s KPC Outbreak and Intensive IPC Intervention

11 11 Antimicrobial Resistance spread into and within the UK CRO colonized residents or visitors Non-human reservoirs: animals and environment Military and civilian casualties from conflict zones Hospital treatment or travel overseas Inter-hospital transfers (UK) Non-human reservoirs: foodstuffs (domestic or imported) Community Carriage? Medical Tourism Elective & cosmetic


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