Multiple drug resistance

As a multi-drug resistance ( Latin compound ) is called in medicine a form of antibiotic or antiviral drug resistance in the so-called germs (bacteria or viruses) against several different / quasi ( almost) all antibiotics or antivirals are insensitive. They are also referred to as MRE germs / Multi-drug resistant pathogens.

Causes

Multidrug resistance of bacteria to antibiotics in medicine is an ever increasing problem dar. There are various causes that lead to an increase in multi-drug resistance:

Multidrug-resistant strains of problem

NDM -1 strains

According to an article in the journal " The Lancet ", according, were discovered world bacterial strains with the NDM -1 (New Delhi metallo- β -lactamase 1) designated gene, which are against all known antibiotics except tigecycline and colistin, be resistant. The gene is not yet surfaced in the Gram- negative enteric bacteria Escherichia coli and Klebsiella pneumoniae and especially common in India and Pakistan. There are cases in the UK, the Netherlands, Australia and Sweden have also been discovered, often after surgery (especially plastic surgery ) in the former Asian countries.

Methicillin -resistant Staphylococcus aureus (MRSA ) strains

Since 1963 Staphylococcus aureus strains are described which have a mutation in their penicillin - binding protein II (PBP II) and therefore against all beta -lactam antibiotics (including, but against so-called beta -lactamase - resistant AB: methicillin, oxacillin, flucloxacillin, inter alia, called staphylococcal antibiotics) are resistant. If they also have a resistance to other drug classes, few preparations for the treatment (eg, glycopeptides, such as vancomycin or teicoplanin or newer and more expensive drugs, such as linezolid from the class of oxazolidinones or tigecycline from the class of glycylcyclines ) are used. MRSA are now found worldwide and are mainly used in intensive care to a growing problem. Thus, the incidence of disease (incidence) in intensive care units in the United States is already > 50% in southern Europe and France > 30 %. In Germany, the incidence is in hospital at around 15 to 20 %, but is subject to large regional variations. Also at approximately 2.5% of all residents of nursing homes MRSA can be isolated. Like other S. aureus strains can also MRSA colonization germ occur on the nose and throat, without the patient ill. This results in germ reservoirs, which can infect other immunocompromised patients. Are particularly dangerous germ settlements at hospital staff, since a continuous risk of infection in patients with immunodeficiency ( eg open wounds, intravascular catheters, dialysis or ventilator requirement) is given.

Vancomycin - intermediate - sensitive Staphylococcus aureus (VISA ) strains

For several years occur in Japan MRSA strains that are intermediately sensitive also to glycopeptides. Individual cases have also occurred in the United States, France, Hong Kong and Thailand. It is probable that these tribes will continue to spread.

Vancomycin -resistant Staphylococcus aureus ( VRSA ) strains

From actually vancomycin - resistant S. aureus ( VRSA ) have only been very few cases described in the U.S.. They are in contrast to the VISA strains characterized by the fact that they have the the glycopeptide resistance coding, from vancomycin / glycopeptide - resistant enterococci (VRE / GRE) derived vanA gene.

Extended -spectrum β -lactamase -producing pathogens

Extended-spectrum β -lactamase ( ESBL ) producing pathogens are bacteria, which are represented by a point mutation in which the β -lactamase enzyme expressed genes is now able to produce the extended-spectrum β -lactamase. This altered enzyme may be a wider range of β -lactam antibiotics containing columns. ESBL -carrying bacteria are therefore resistant to penicillins, cephalosporins ( generation 1-4) and against monobactams. Mainly E. coli and Klebsiella species ( gram-negative bacteria ) have ESBL genes.