Antibiotic Resistance in Enterobacteriaceae

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1 Antibiotic Resistance in Enterobacteriaceae Prof. P. Nordmann 16 es JNI, Nancy, du 10 au 12 juin

2 16 es JNI, Nancy, du 10 au 12 juin 2015

3 16 es JNI, Nancy, du 10 au 12 juin 2015

4 16 es JNI, Nancy, du 10 au 12 juin 2015

5 Main microbial pathogens for humans Gram positives Staphylococcus Gram negatives Enterobacteriaceae (E. coli, K.pneumoniae ) Pseudomonas aeruginosa Enterococcus, Streptococcus Acinetobacter baumannii 16 es JNI, Nancy, du 10 au 12 juin 2015

6 Emerging resistance threats, CDC USA-2014 Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL) Multi-resistant Staphylococcus aureus Urgent threat Serious threat Possible threat Carbapenem-resistant Enterobacteriaceae Antibiotic resistant Mycobacterium tuberculosis 16 es JNI, Nancy, du 10 au 12 juin 2015

7 Extended-spectrum ß-lactamases (ESBL) Penicillin/Amino-penicillins Penicillin G Ureido-penicillins Ticarcillin 1/2nd generation cephalosporins Cefazolin 3 rd generation cephalosporins Ceftriaxone 4/5thgeneration cephalosporins Cefepime Ampicillin Amoxicillin Piperacillin Cefuroxime Ceftazidime Ceftaroline ESBL: increasing resistance towards beta-lactam antibiotics 16 es JNI, Nancy, du 10 au 12 juin 2015

8 Multidrug resistance of ESBL-producing Escherichia coli 16 es JNI, Nancy, du 10 au 12 juin 2015 ß-Lactams Non- ß-lactams

9 16 es JNI, Nancy, du 10 au 12 juin 2015

10 Resistance to expanded-spectrum cephalosporins. Infections. Enterobacteriaceae in Europe 2005 E.coli K. pneumoniae es JNI, Nancy, du 10 au 12 juin 2015

11 ESBL prevalence in E. coli and K. pneumoniae Low prevalence Intermediate prevalence High prevalence 16 es JNI, Nancy, du 10 au 12 juin 2015 Hawser et al ; Rhomberg et al ; Bell et al ; Gagliotti et al. 2011

12 Enterobactericeae ESBL (+) in France in 2012 (n=50,378) ESBL Prevalence (%) Courtesy R. Bonnet 16 es JNI, Nancy, du 10 au 12 juin 2015

13 E. coli from bloodstream infections: turning nasty Fluoroquinolones: 2001/13 16 es JNI, Nancy, du 10 au 12 juin rd Generation cephalosporins: 2001/13

14 Treatment of infections due to ESBL producers Activity spectrum + in-vitro activity spectrum+ co-resistances Urinary infections (per os) Sepsis )IV) Amino, ureidopencillins Amoxicillin/clav Piperacilline/Tazobactam Cephalosporines 3/4 th generations Carbapenem Aminoglycosides Quinolones/Fluoroquinolones Trimethoprim/Sulfamethoxazole Colistin Tigecycline Fosfomycin/Nitrofuarantoine 16 es JNI, Nancy, du 10 au 12 juin 2015

15 Day 14 mortality per antibiotic class for bloostream infections due to ESBL producers Paterson 16 es et JNI, al., Nancy, CID, du au 12 juin 2015

16 16 es JNI, Nancy, du 10 au 12 juin 2015

17 Broad-spectrum ß-lactamases in gram negatives Penicillins Cephalosporins Carbapenems Extended-spectrum ß-lactamases (ESBL); CTX-M Carbapenemases: NDM, KPC, OXA es JNI, Nancy, du 10 au 12 juin 2015

18 Emergence of carbapenemases in Enterobacteriaceae KPC Klebsiella pneumoniae OXA-48 Klebsiella pneumoniae NDM-1 Klebsiella pneumoniae NmcA Enterobacter cloacae IMP-1 Serratia marcescens 2004 FRANCE (TURKEY) Poirel, Heritier, Tolün, Nordmann AAC 2004 : 48: SWEDEN (INDIA) Yong, Toleman, Giske, Cho, Sundman, Lee, Walsh AAC 2009 : 53: es JNI, Nancy, du 10 au 12 juin 2015

19 16 es JNI, Nancy, du 10 au 12 juin 2015

20 16 es JNI, Nancy, du 10 au 12 juin 2015

21 16 es JNI, Nancy, du 10 au 12 juin 2015 K. pneumoniae

22 16 es JNI, Nancy, du 10 au 12 juin 2015 The importance of E.coli

23 16 es JNI, Nancy, du 10 au 12 juin 2015

24 Carbapenemase producers in France Selection criteria ; ertapenem 1 mg/l imipenem meropenem 4mg/L ertapenem 16 es JNI, Nancy, du 10 au 12 juin 2015

25 Episodes d EPC, France, , par mois de signalement Bilan au 04 septembre 2014 (N= 1210 épisodes) E. coli; 28% 1210 épisodes au total 2009 : 10, 2010 : 28, 2011 : 113, 2012 : 233, 2013 : 405, 2014 : es JNI, Nancy, du 10 au 12 juin 2015

26 Carbapenemase producers in Enterobacteriaceae- France- Antibiotic Resistance Reference Center Species n K. pneumoniae 410 E. coli 116 E. cloacae % 1.4% 2.8% 4.6% K. pneumoniae E. coli E. cloacae Enterobacter spp. Citrobacter spp. Autres Enterobacter spp. 9 Citrobacter spp. 24 Autres 26 Total % 64.5% 16 es JNI, Nancy, du 10 au 12 juin 2015 X 3 in 2 years of time P. Nordmann, personal and unpublished data

27 16 es JNI, Nancy, du 10 au 12 juin 2015 Carbapenemases in the community

28 16 es JNI, Nancy, du 10 au 12 juin 2015

29 16 es JNI, Nancy, du 10 au 12 juin 2015 Carbapenemase producers, France: the future

30 16 es JNI, Nancy, du 10 au 12 juin 2015 The impact of carbapenemase producers in the USA

31 16 es JNI, Nancy, du 10 au 12 juin 2015

32 16 es JNI, Nancy, du 10 au 12 juin 2015 Kp KPC-2

33 Fighting back against antibiotic resistance Four Core Actions to Prevent Antibiotic Resistance 1. Preventing infections, preventing the spread of resistance 4.Developing novel diagnostic tests and new drugs 2. Tracking 3. Improving antibiotic prescription/stewardship 16 es JNI, Nancy, du 10 au 12 juin 2015

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