Cipher: 2620
Nomenclature: Multi-resistant bacteria - source, evolution and detection methods
Study programme: Molecular biosciences
Module: Biomedicine
Case holder:

Izv.prof.dr.sc. Domagoj Drenjancevic
Doc.dr.sc. Ivana Haršanji Drenjancevic
Institution of the case holder:

(DD) Faculty of Medicine, J. J. Strossmayer University of Osijek
(IHD) Clinical Hospital Center Osijek, School of Medicine, J.J. Strossmayer University of Osijek
Contributors - Contractors:

Dr.sc. Maja Bogdan, research associate
Subject status: Electoral College
The year in which the case is submitted: Year I
The semester in which the case is submitted: Semester II
Subject objective:

Understand the principle of prevention and methods of detection of the most common multi-resistant pathogens as well as epidemiology and
understand the role of health procedures, care, treatment and diagnostic procedures as well as the role of the hospital environment in the spread of hospital infections.
Case contents:

Definition, evolution and source of multi-resistant bacteria. Antibiotic consumption, selective pressure of antibiotics and the development of resistance. Mechanisms of bacterial resistance to antibiotics. Reservoirs and the spread of multi-resistant bacteria. Use of antibiotics in agrarian inductia and food production. ESCAPE bacteria. Multi-resistant Gram positive bacteria causative agents of hospital infections: methicillin resistant Staphylococcus aureus (MRSA), resistance to vancomycin in S. aureus – vancomycin moderately sensitive S. aureus (VISA) and vancomycin resistant S. aureus (VRSA), vancomycin resistant enterococci VRE, resistant Streptocccus pneumoniae. Multi-resistant Gram negative bacteria: enterobacteriaceae producing beta-lactamase of the extended spectrum Escherichia coli, Klebsiella pneumoniae, carbapenemase-producing anterobacteriaceae (CRE), multi-resistant nonfermentors Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Resistance of Gram negative bacteria to spare antibiotics – pancreatitis bacteria. Laboratory detection of multi-resistant bacteria.
Development of bacterial resistance in the outpatient environment. Monitoring of bacterial resistance to antibiotics at the levels of the institution and the state. National Program for Bacterial Control on Antibiotics. Interdisciplinary section for controlling bacterial resistance to antibiotics (ISKRA). Resistant bacteria causative agents of outpatient infections: Streptococcus pneumoniae, outpatient methicillin resistant Staphylococcus aureus (CA-MRSA) Salmonella, ESBL enterobacteriaceae, Mycobacterium tuberculosis. Resistance of bacteria to antibiotics prescribed to the outpatient population – resistance of streptococcus to macrolides.
Prevention of infections caused by multi-resistant bacteria. Prevention and control measures for infections caused by resistant bacteria.
Learning outcomes: competences, knowledge, skills that the subject develops:

1. Explain pathogenesis and detection of multi-resistant bacteria, their source and evolution.
2. Identify the most common multi-resistant bacteria MRSA, VRE, ESBL bacteria and nonfermentors.
3. Propose ways to prevent hospital infections.
4. To analyze the principle of diagnosis of infections caused by multi-resistant bacteria, prevention and control over the spread of bacterial resistance.
5. Review the use of laboratory methods of detection of multi-resistant bacteria in biomedical research in the field of microbiology and infectious diseases.
ECTS Credits 4
Lectures 15
Seminars (IS) 5
Exercises (E) 0
Altogether 20
The way of teaching and acquiring knowledge:

Attendance and active participation in seminars.
Ways of teaching and acquiring knowledge: (notes)
Monitoring and evaluating students (mark in fat printing only relevant categories) Attendance, Teaching activities, Mandatory seminar work
Rating method: Oral exam, Essay/Seminar
Mandatory literature:

1. Bacterial Resistance to Antimicrobials, 2nd edition. Lewis K, Salyers AA, Taber HW Richard GW, editors. CRC Press, Taylor and Francis Group, Boca Raton: 2008
2. Nikaido H. Multidrug resistance in bacteria. Anna Rev Biochem 2009;78:119-46.
3. Amin's RI, Mackie RI. Evolution and ecology of antibiotic resistance genes. FEMS Microbiol Lett 2007;271:147-61.
4. Magiorakos AP1, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
5. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1-12.
Supplementary (recommended) literature:

1. Singh A, Goering RV, Simjee S, Foley SL, Zervos MJ. Application of molecular techniques to the study of hospital infection. Clin Microbiol Rev. 2006;19:512-30.
2. Antibiotic Resistance, Methods and Protocols. Stephen H. Gillespie, editor. Series: Methods in Molecular Biology, Vol. 48. Humana Press; New Jersey: 2001.
3. Mayhall G. (editor): Hospital Epidemiology and Infection Control, 3rd edition; Lippincott Williams&Wilkins, Philadelphia, 2004.
4. Management of Multiple Drug-Resistant Infections. Gillespie, SH editror. Humana Press: New Jersey, 2004.
How to monitor the quality and performance performance (evaluation):

The success of the course will be evaluated annually by the joint expert committee of the Rudjer Boskovic Institute, the University of Dubrovnik and the University of Osijek, and the leaders will receive information from the participants about the adequacy of the program and performance by the leadership through the survey.