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Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

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Page 1: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Community-acquired bacterial infectionsbacterial infections

Page 2: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

�The most frequent etiologic agent of bacterial tonsillitis and tonsillopharyngitis is Streptococcus pyogenesStreptococcus pyogenes

(80-90 %)

Page 3: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

InitialInitial antibioticantibiotic therapytherapy ofof bacterialbacterialtonsillitistonsillitis andand tonsillopharyngitistonsillopharyngitis

��AntibioticsAntibiotics ofof I. I. choicechoice––penicillinpenicillin (3(3--4 x 4 x dailydaily))––penicillinpenicillin (3(3--4 x 4 x dailydaily))––macrolidesmacrolides(in (in patientspatientswithwith allergyallergyto to penicillinspenicillins))

Page 4: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

TheThe developmentdevelopment ofof StreptococcusStreptococcus pyogenespyogenes resistanceresistancetoto eryterythhromycinromycin inin 19919977 -- 20020033 ((olomoucolomouc regionregion))

The drug of I. choice in bacterial tonsillitis and tonsillopharyngitis is penicillin, except patients

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Urbánek K, Kolář M, Čekanová L. Pharmacy World and Science. 2005, 27:104-107.

except patients with allergy to penicillins

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Page 5: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology andand treatmenttreatment ofofperitonsillarperitonsillar andand tonsillartonsillar abscessabscess

�Etiology:– Streptococcus pyogenes

– anaerobic microbes

�ATB of I. choice:– penicillin

– anaerobic microbes (Peptostreptococcussp.)

�Alternative ATB:– clindamycin

Page 6: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

�Pneumonia–typical pathogens–atypical pathogens

�Pneumonia–community-acquired–hospital-acquired (nosocomial)

Page 7: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia

–typical pathogens �Streptococcus pneumoniae �Haemophilus influenzae �Haemophilus influenzae �Moraxella (Branhamella) catarrhalis�Staphylococcus aureus�Klebsiella pneumoniae�other

Page 8: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology ofof communitycommunity--acquiredacquiredpneumoniapneumonia

–atypical pathogens�Chlamydophila pneumoniaeChlamydophila pneumoniae�Chlamydophila psittaci�Mycoplasma pneumoniae�Legionella pneumophila�others

Page 9: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

AccordingAccording thethe data data fromfrom olomoucolomoucregion region itit isis possiblepossible to to makemake a a

conclusionconclusion::

�typical pathogens form about 65 %

�atypical pathogens form about 35 %�atypical pathogens form about 35 %–chlamydia pneumonias 24 %

–mycoplasma pneumonias 11 %

Page 10: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology ofof pneumoniapneumoniain in childrenchildren

�Haemophilus influenzae

�Mycoplasma pneumoniae (mainly in children 5 years old and older)

�Streptococcus pneumoniae

�Klebsiella pneumoniae

Page 11: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

AccordingAccording thethe data data fromfrom olomoucolomoucregion region itit isis possiblepossible to to makemake a a

conclusionconclusion (etiology (etiology ofof pneumoniapneumoniain in childrenchildren):):

–Haemophilus influenzae 36 %–Mycoplasma pneumoniae 25 %–Klebsiella pneumoniae 14 %–Streptococcus pneumoniae 11 %–others 14 %

Page 12: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

InitialInitial antibioticantibiotic therapytherapy ofofcommunitycommunity--acquiredacquired pneumoniapneumonia

�Drug of I. choice

– amoxicillin

�Alternative antibiotics

– macrolides (e.g. clarithromycin, azithromycin)

– doxycycline (in adults and children older than 12

years)

Page 13: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

BacterialBacterial etiology etiology ofof acuteacute otitis media otitis media in in olomoucolomouc regionregion

Streptococcus pneumoniae- 49%

Moraxella (B)catarrhalis

others - 16%

Haemophilus influenzae- 21%

catarrhalis- 14%

Page 14: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology andand treatmenttreatment ofofotitis media otitis media acutaacuta

�Etiology:– Streptococcus

pneumoniae

Haemophilus

� Antibiotic of I. choice:– amoxicillin

� Alternative antibiotic:– Haemophilus

influenzae

– Moraxella (B) catarrhalis

� Alternative antibiotic:– amoxicillin/clavulanic acid– ampicillin/sulbactam– cephalosporins II. gen.

(cefuroxime, cefprozil)– in patients with allergy to

penicilllins - macrolides

Page 15: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology andand treatmenttreatment ofofotitis media otitis media chronicachronica

�Etiology:– gram-negative rods

(Proteusspp.,

� ATB of I. choice:– fluorochinolones

(ofloxacin, ciprofloxacin)(Proteusspp., Pseudomonas aeruginosa)

– Staphylococcus aureus

– anaerobic microbes

� Alernative ATB:– gentamicin

– ceftazidime

– gentamicin+ceftazidime

Page 16: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

BacterialBacterial etiology etiology ofof acuteacute sinusitissinusitisin in olomoucolomouc regionregion

Streptococcuspneumoniae- 61%

Moraxella (B)catarrhalis- 5%

others - 12%

Haemophilus influenzae- 22%

Page 17: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology andand treatmenttreatment ofof sinusitissinusitis acutaacuta

�Etiology:– Streptococcus

pneumoniae Haemophilus influenzae

� Antibiotic of I. choice:– amoxicillin

� Alternative antibiotic:

– amoxicillin/clavulanic acidinfluenzae– Moraxella (B)

catarrhalis

– amoxicillin/clavulanic acid

– ampicillin/sulbactam

– cephalosporins II. gen.

(cefuroxime, cefprozil)

– in patients with allergy to

penicilllins - macrolides

Page 18: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology andand treatmenttreatment ofofepiglottitisepiglottitis

�Etiology:– Haemophilus

influenzae type b

� ATB of I. choice:– cephalosporins of III. generation

– ampicillin

– amoxicilin/clavulanic acid– amoxicilin/clavulanic acid

– ampicillin/sulbactam

– cefuroxime

� Alternative ATB:– chloramfenikol

(in case of allergy to penicillins)

Page 19: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Etiology Etiology ofof communitycommunity--acquiredacquiredurinaryurinary tracttract infectionsinfections

�Escherichia coli

�Proteus mirabilisProteus mirabilis

�Enterococcus faecalis

�Streptococcus agalactiae

�others

Page 20: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Bacterial etiology of community-acquired urinary tract infections in olomouc region

E.faecalis9%

S.agalactiae8%

others4%

E.coli68%

P.mirabilis11%

9%

Page 21: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

ResistanceResistance ofof E. E. colicoli to to antibioticsantibiotics((olomoucolomouc region, in %)region, in %)

Page 22: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

TheThe developmentdevelopment ofof EscherichiaEscherichia colicoli resistanceresistancetoto ofloxacinofloxacin inin 19919977 -- 20020022 ((olomoucolomouc regionregion))

6

8

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DD

D/1

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rezistence k ofloxacinu

spotřeba fluorochinolonů

0

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Urbánek K, Kolář M, Strojil J, et al. Pharmacoepidemiology and Drug Safety. 2005, 14:741-745.

Page 23: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

InitialInitial antibioticantibiotic therapytherapy ofof communitycommunity--acquiredacquired urinaryurinary tracttract infectionsinfections

�Drug of I. choice– nitrofurantoin, cotrimoxazol, trimethoprim,

(amoxicillin, oxolinic acid)(amoxicillin, oxolinic acid)

�Alternative antibiotics– amoxicillin/clavulanic acid

– ampicillin/sulbactam

– cephalosporins II. gen. (cefuroxime, cefprozil)

Page 24: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

HospitalHospital--acquiredacquiredbacterialbacterial infectionsinfections

Page 25: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Therapy in earlyTherapy in early--onset onset hospitalhospital--acquired pneumoniaacquired pneumonia

Potential pathogen Recommended antibiotic

Streptococcus pneumoniae

ampicillin/sulbactamor

Haemopilus influenzae

Staphylococcus aureus methicillin- oramoxicillin/clavulanic

acid

event. + gentamicin

Staphylococcus aureus methicillin-sensitive

Antibiotic-susceptible Escherichia coli Klebsiella pneumoniaeEnterobacter spp.

Page 26: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

Therapy in lateTherapy in late--onset onset hospitalhospital--acquired pneumoniaacquired pneumonia

Potential pathogens Antibiotic therapy

Multidrug-resistant pathogensPseudomonas

carbapenem (imipenem, meropenem)or

β-lactam/β-lactamase inhibitor Pseudomonas aeruginosaKlebsiella pneumoniae(ESBL+) Acinetobacter spp.

β-lactam/β-lactamase inhibitor (piperacillin-tazobactam)

event. + aminoglycoside

(amikacin, gentamicin, tobramycin)

MRSA linezolid or vancomycin

Page 27: Community-acquired bacterial infectionsold.lf.upol.cz/fileadmin/user_upload/LF-kliniky/mikrobiologie/general_medicine/... · – amoxicillin Alternative antibiotics – macrolides

EtiologicEtiologic agentsagents ofof HAP in HAP in ICUsICUs(University (University HospitalHospital Olomouc)Olomouc)