• Carbapenems are β - lactams, often “drug of last resort”. • Fatal in up to 50% of patients who become infected.
Gonorrhea • Neisseria gonorrhoeae – gram-negative, diplococcus – referred to as Gc or the gonococcus • Gonorrhea, a sexually transmitted infection (STI), is the second most commonly reported infectious disease in the United States, with 700,000 cases per year. • Gonorrhea represents 88 million of an estimated 448 million new cases of curable STIs – also includes syphilis, chlamydia and trichomoniasis – worldwide each year. • Infects mucous membranes of the genitourinary tract, eye, rectum, and throat
Gonorrhea… • clinical manifestations – symptoms in males • urethral discharge of yellow, creamy pus, and painful, burning urination – symptoms in females • vaginal discharge beginning 7 to 21 days after infection • BUT… often asymptomatic , goes untreated , leading to infection of fallopian tubes and surrounding tissue = pelvic inflammatory disease ( PID ) • major cause of infertility and ectopic pregnancies • disseminated gonococcal infections • involvement of joints, heart, and throat
Neisseria gonorrhoeae Gc can also be transmitted from mother to child during birth resulting in: • opthalmia neonatorum (conjunctivitis of the newborn) – newborns’ eyes infected as they pass the birth canal of an infected mother – also caused by Chlamydia – prevention is by antibiotic eye drops or silver nitrate in newborns at birth
N. gonorrhoeae Virulence Factors • attach to microvilli or mucosal cells by pili and protein II (opacity) protein adhesins • survive phagocytosis by neutrophils • fibrosis results and may lead to stricture or urethral closing
Gonorrhea… • diagnosis – culture of bacterium followed by gram stain, oxidase test, and determination of cell and colony morphology; DNA probe test • treatment, prevention, and control – antibiotic therapy • penicillin resistance common – public education, diagnosis and treatment of asymptomatic individuals, condom use, and quick diagnosis and treatment of infected individuals
Drug-resistant Neisseria gonorrheae N. gonorrhoeae has progressively developed resistance to every antibiotic drug prescribed to treat it. Current treatment guidelines in the US are dual therapy with an injectable cephalosporin and either azithromycin or doxycycline. Dual therapy is recommended to address the potential emergence of gonococcal cephalosporin resistance, aka the “ticking time bomb”.
Enterococcus faecalis • Commensal of the gastrointestinal tract • Opportunistic pathogen – Causes up to 10% of nosocomial infections – urinary tract infection, endocarditis, wound infections, bacteremia, meningitis • “Hardy” bug – Grow in wide range of temperatures, pH, salt – Intrinsic and acquired antibiotic resistance – Lateral vancomycin transfer to MRSA
Enterococcus faecalis • Tenacious bacteria • Antibiotic resistance – innate and acquired • Biofilm-associated infections – Bacterial community, antibiotic- and immune-resistant 40,000/year 25,000/year 1100/year 110,000/year