Multi-Drug Resistant Organisms

Introduction

Multi-drug resistant organisms (MDRO) are bacteria that are resistant to several antibiotics. Some bacteria are naturally resistant to certain types of antimicrobials, whilst others develop or acquire resistance.

Antimicrobial stewardship, “Start Smart Then Focus”, is vital to minimising further antimicrobial resistance. Therefore, the Trust Antimicrobial Prescribing Policy must be followed at all times and where necessary, further advice should be sought from the Consultant Microbiologist.

There are different types of bacteria that can become multi-drug resistant, especially:

• Gram negative organisms (for example E.Coli, Klebsiella or Pseudomonas)
• Gram positive organisms (for example Meticillin Resistant Staphylococcus Aureus (MRSA) or Glycopeptide Resistant Organisms (GRE, sometimes referred to as Vancomycin Resistant Organisms (VRE)).

MDRO’s may colonise an individual on a temporary or permanent basis, i.e. harmless carriage without associated disease / tissue damage or immune response. In some instances, MDROs may cause infection, i.e. active disease / tissue damage and with associated signs and symptoms specific to the type of infection caused, e.g. wound infection, with associated inflammation, redness, delayed wound healing and exudate. Where patients develop infection due to a MDRO, the infection is generally no more severe than those caused by antibiotic sensitive microorganisms. However, for infections caused by a MDRO there are limited antibiotic choices for treatment, and in some cases, there are no sensitive antimicrobials available at all; this can adversely impact patient morbidity and mortality. Colonisation is a precursor to infection in vulnerable individuals. In terms of infection prevention and control, both colonisation and infection with a MDRO are important, as either can lead to further spread.

Policy Details

See also:

• Standard IPC Policy
• MRSA Policy
• CPE Policy