Multidrug Resistance in Healthcare: Your Questions Answered

Laura A. Stokowski, RN, MS; Edward J. Septimus, MD

Disclosures

May 12, 2011

In This Article

Multidrug Resistant Organisms in Healthcare

Every time we post an article about antibiotic resistance, infection control, or related topics, it stimulates more questions from readers about infection control issues in healthcare. This is precisely what happened after we published Antibiotic Resistance: A Primer. We took your follow-up questions about prevention, surveillance, and infection control practices to an infection control specialist, Dr. Edward Septimus, Medical Director of Infection Prevention and Epidemiology at HCA Healthcare System in Houston, Texas, and member of the Infectious Diseases Society of America's (IDSA) Antimicrobial Resistance Workgroup, and former member of the IDSA's board of directors.

Your questions spanned the range of healthcare settings, from acute care to long-term care, from ambulatory care settings to the home, and how to manage the patient with multidrug-resistant organisms (MDROs) in each of these settings.

The most serious and challenging MDROs in healthcare right now are:

  • Methicillin-resistant Staphylococcus aureus (MRSA)

  • Vancomycin-resistant enterococcus (VRE)

  • Clostridium difficile

  • Extended-spectrum beta lactamase-producing organisms

  • Other multidrug-resistant gram-negative pathogens

  • Multidrug-resistant tuberculosis

According the Centers for Disease Control and Prevention (CDC) 1 of every -20 patients develops healthcare-associated infection (HAI), and more than 70% of HAIs are caused by MDROs, defined as microorganisms (predominantly bacteria) that are resistant to 1 or more classes of antimicrobial agents.[1] All healthcare settings are affected by the emergence and transmission of MDROs.

Patients vulnerable to colonization and infection include those with severe disease, especially those with compromised host defenses from underlying medical conditions, recent surgery, or indwelling medical devices. HAIs include catheter-related bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, gastrointestinal infection, sepsis, surgical site infections, and skin and soft tissue infections. Furthermore, many patients are asymptomatic carriers of MDROs. Without being infected themselves, these lingering pathogens pose serious risks for the less immunocompetent patients in the healthcare system.

Research continues to reveal the important role of the environment in transmission of MDROs. Facilities are attempting to battle such transmissions by having dedicated, well-trained cleaning staff who follow appropriate techniques for environmental cleaning. MDROs can survive on inanimate surfaces, and colonize the hands of healthcare workers just as easily as if they touch the skin of colonized patients. Most successful eradications of MDROs in healthcare settings have employed comprehensive approaches comprised of multiple, concurrent infection control measures, such as enhanced environmental cleaning and judicious antibiotic use.[1]

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