3-and 4-MRGN MRGN New identification of multidrug-resistant gram-negative pathogens on the findings of the IMD or Country We set the RKI proposal for a uniform labeling of multidrug-resistant gram-negative bacilli and give you with this Labinfo background and an overview of the proposed specific hygiene measures for hospital patients by the hand. Besides the known, treatable only with reserve antibiotics, Gram-positive pathogens such as MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin-resistant enterococci) play the multi-resistant Gram-negative rods (MRGN) an increasing role as a pathogen of nosocomial infections - especially in the context of clusters and outbreaks. Infections with these pathogens are associated with a higher morbidity and mortality. MRGN- rod bacteria are grown in recent years increasingly become a problem in the treatment of hospitalized patients. To prevent nosocomial spread, the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) has proposed a uniform identification of these pathogens and defines itself be derived from specific hygiene measures for hospital patients Designations for multidrug-resistant Gram-negative bacilli With increasing resistance development a confusing variety of names this phenomenon has emerged:., Eg name by the underlying mechanism (such as AmpC, ESBL), according to the site of the primary isolation (such as NDM), according to the relevant pathogen species (such as KPC) or according to the number of individual resistances (such as PDR, and MDR). What does MRGN? To simplify the KRINKO has proposed a uniform designation for multi-resistant Gram-negative bacilli, which involves the clinical relevance of the phenomenon with. Considering, therefore, are only resistance to antibiotics, which are used in critically ill patients. Regardless of the underlying mechanism of resistance are known: multidrug-resistant Gram-negative rods resistant to three of the four groups of antibiotics as 3MRGN and multidrug-resistant Gram-negative rods resistant to 4 of 4 classes of antibiotics than 4 MRGN. 1 - 3MRGN (Multidrug-resistant gram-negative rods resistant to three of the four groups of antibiotics) 2 - 4MRGN (Multidrug-resistant gram-negative rods resistant to 4 of 4 groups of antibiotics) This new classification applies to Enterobacteriaceae as well as Pseudomonas aeruginosa and Acinetobacter baumanii. MRGN and list by Section 23 The majority of MRGN was previously featured on the findings as conspicuous according to § 23 IfSG. In contrast to § 23 IfSG not only resistant, but also the intermediate sensitive pathogens are detected in the MRGN. This may result in differences between the two classifications in each individual case. What are the consequences of the proof of MRGN? The KRINKO published 2012 measures to prevent the spread of MRGN in October. The MRGN therefore additional measures are necessary in addition to the recording obligation in Section 23 IfSG policy. 1) risk areas according to individual risk assessment to determine z. Example based on the patients good and architectural-structural factors, with intensive care units, incl. neonatology, and hematology-oncology stations as areas with vulnerable patients apply. 2) In neonatology may already have a sole resistance to 3rd Generation cephalosporins for certain pathogens (such as K. pneumoniae, E. cloacae, S. marcescens, P. aeruginosa, Acinetobacter spp., C. koseri) interdisciplinary reflection on the need for hospital hygiene intervention draw after itself 3) A joint insulation (insulation cohort) can only be done for patients with a MRGN the same species with the same resistance pattern. 4) The risk patients with patients applys recent contact with the health system in countries with endemic occurrence and patients to 4MRGN-positive patients Contact had, that were maintained in the same room These recommendations are to be performed at hospitals and medical facilities where invasive therapies (eg. B. breaths in neurological rehabilitation). For outbreak special measures are taken. In the new version of Section 23 of the Infection Protection Act (IfSG) also doctors and representatives of other health professionals are aware of their responsibilities to control the spread of multidrug-resistant pathogens. We therefore give the indication of the presence of MRGN on findings of ambulatory patients. So there appropriate measures can be taken at admission of the patient to a hospital.
Posted on: Wed, 01 Oct 2014 19:26:41 +0000
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