Drug-Resistant Superbugs, Multi-drug Resistant Organisms: MRSA, VRE, Clostridium difficile, and CRE (Online CE Course)
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Authors: Carolyn M. Law, PhD, MT(AMT); Catherine Dragoni, MT(ASCP)SMCo-author: Judi Bennett, MT, BSM
Reviewer: Alexandru Casapu, MBA, MLS(ASCP)CM
In light of the recent death of a Nevada woman infected with carbapenem-resistant Enterobacteriaceae (CRE), we wonder how prepared our laboratory professionals are for the challenges that may lie ahead.
To aid in the continued education about CRE and other multi-drug resistant microbes, we're republishing our Multi-drug Resistant Organisms: MRSA, VRE, Clostridium difficile, and CRE course. New information and updates have been added to address the potential of increased CRE infections.
Multiple drug resistant organisms (MDROs) are a serious problem facing healthcare and the general public. This course details the clinical significance, risk factors, and laboratory detection of these multi-drug resistant organisms: methicillin resistant Staphylococcus aureus, vancomycin resistant Enterococcus species, Clostridium difficile, and carbapenem-resistant Enterobacteriaceae.
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Continuing Education Credits
 | Course number 578-062-18, approved through 9/30/2020 |
 | Course number 20-676440, approved through 9/1/2020 |
Objectives
- Identify the virulence factors that are expressed by drug resistant strains of Staphylococcus aureus, Clostridium difficile, Enterococcus faecium and faecalis, and carbapenem-resistant Enterobacteriaceae.
- List the risk factors and clinical syndromes that are associated with these drug resistant organisms.
- Describe the recommended laboratory procedures involved in screening for and detecting drug-resistant organisms.
- Name the drugs that are currently available for treatment of these infections and describe the proper treatment protocols.
Course Outline
Click on the links below to preview selected pages from this course. - Introduction
- Methicillin Resistant Staphylococcus aureus
- Vancomycin Resistant Enterococci
- Clostridium difficile
- Carbapenem-Resistant Enterobacteriaceae
- MRSA is only a problem for patients who are hospitalized.
- Staphylococcus aureus
- Staphylococcus aureus
- S. aureus Virulence Factors
- The pathogenicity of S. aureus, as well as the frequency with which this organism produces infections, can be attributed to:
- Clinical significance of S. aureus
- Beta-lactam antibiotics and S. aureus
- Which of these describes the mode of action of the beta-lactam class of antibiotics?
- Beta-lactam antibiotics interfere with cell wall synthesis by:
- MRSA
- Beta-lactams and Methicillin Resistant Staphylococcus aureus
- Healthcare (Hospital)-Associated MRSA (HA-MRSA) versus Community-Associated MRSA (CA-MRSA)
- Risk Factors
- The increased resistance of MRSA strains to beta-lactam antibiotics is due to production of which of the following penicillin binding proteins (PBPs)?
- Which are true statements regarding HA-MRSA and CA-MRSA?
- Laboratory Diagnosis of MRSA
- Laboratory Identification of S. aureus
- Screening Cultures for MRSA
- Assume you perform microbiology for an institution submitting surveillance cultures for MRSA. Which isolate should receive further workup to rule out ...
- Susceptibility Testing of Isolates
- Susceptibility Testing
- Selection of Drugs for Testing
- Interpretation of Oxacillin Broth Dilution Tests.
- Interpretation of Oxacillin and Cefoxitin Disk Diffusion Tests
- Detection of Oxacillin Resistance
- Which of the following scenarios represents appropriate detection of MRSA by the Kirby Bauer method?
- A laboratory performs MIC tests, in addition to Kirby Bauer, and a PBP 2a assay on blood culture isolates. Which of the following isolates should be r...
- MRSA Treatment/Vancomycin Resistance in S. aureus
- Testing for Vancomycin Susceptibility
- Testing for Vancomycin Susceptibility
- A laboratory's primary susceptibility testing method is disk diffusion. The cefoxitin disc has a zone size of 19 mm and the vancomycin disc has a zone...
- Future Perspectives: MRSA
- Future Perspectives
- Future Perspectives, continued
- Future Perspectives, continued
- Moving forward, important strategies for dealing with MRSA strains will include which of the following?
- Enterococcus
- Enterococci
- Risk Factors and Resistance
- Enterococci can possess both intrinsic and acquired resistance. Which of the following represents the intrinsic resistance of a typical enterococcal s...
- Vancomycin Resistant Enterococci
- Laboratory Diagnosis of VRE
- Treatment of Resistant Enterococci
- Clostridium Species
- Clostridium difficile
- Laboratory Diagnosis of CDAD
- Laboratory Detection of C. difficile
- Stool Culture
- Cell Cytotoxicity Neutralization Assay (CCNA)
- Enzyme Immunoassay Methods
- Various methods have been employed for detection of C. difficile disease: cultivation of the organism, cell cytotoxin neutralization assays, and enzym...
- Glutamate Dehydrogenase (GDH) Antigen Assays
- Molecular Methods
- Which of the following approaches for diagnostic testing have been indicated by recent literature?
- Treatment of C. difficile Infection
- Future perspectives
- Future Perspectives: CDI/CDAD
- Carbapenem-Resistant Enterobacteriaceae
- Enterobacteriaceae and Spectrum of Disease
- CRE Defined and Risk Factors
- Mechanisms of Resistance
- Carbapenemase-Producing Enterobacteriaceae
- What carbapenemase is produced most commonly by CRE encountered in the United States?
- Laboratory Diagnosis of CRE
- Detection, Identification, and Susceptibility Testing of CRE
- Summary: CRE Versus CP-CRE
- When using current antimicrobial susceptibility testing (AST) breakpoints, it is recommended by CLSI that laboratories should also routinely implement...
- Treatment and Control of CRE
- Future Perspective: CRE
- References
Additional Information
Level of instruction: Intermediate
Intended audience: Medical laboratory scientists, medical technologists, and technicians, This course is also appropriate for clinical laboratory science students and pathology residents.
Author information: Carolyn M. Law, PhD, MT(AMT) is the CEO of Celtic Labs Diagnostic Microbiology Services in Trinidad. She holds a PhD in Microbiology from National University of Ireland, Maynooth.
Author information: Catherine Dragoni, MT(ASCP)SM received her BS degree in medical technology fr om the State University of New York, Upstate Medical Center, Syracuse. She began her career as a bench microbiologist at Maine Medical Center, Portland, Maine. Currently she is the Assistant Chief Technologist of Microbiology and Molecular Pathology at NorDx Laboratories, Scarborough, Maine.
Co-author information: Judi Bennett, MT, BSM is currently a Program Director for MediaLab, Inc. in Lawrenceville, Georgia. She has over 30 years of medical laboratory experience in an acute care hospital setting as a laboratory manager, senior clinical applications specialist, point-of-care coordinator, microbiology supervisor, and generalist technologist. Judi has experience speaking at various professional conferences and is the author of numerous peer-reviewed publications.
Reviewer Information: Alexandru Casapu, MBA, MLS(ASCP)CM, PBTCM has over 20 years of experience as a medical laboratory scientist, section supervisor, and laboratory manager. He is the former Director of Clinical Laboratory Technology Program at Georgia Piedmont Technical College. He is currently a Program Director at MediaLab, Inc. Alexandru holds BS degrees in Biology and Medical Technology from Clark Atlanta University and a MBA from the University of Georgia.
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