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Infections with multidrug resistant organisms (MDROs)

Infections with multidrug resistant organisms (MDROs) - What it is

Globally, we have seen an increase in infections with drug resistant microbes. Drug resistance mechanisms can occur naturally or it can be acquired. More often than not, drug resistance mechanisms in microbes is acquired and linked to the indiscriminate use of antibiotics. 

Some examples of multidrug-resistant organisms (MDROs) include the following:
  • Multidrug resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Enterococcus (VRE), multidrug resistant Streptococcus pneumoniae as well as multidrug resistant gram negative bacteria which includes extended spectrum beta-lactamases (ESBL), carbapenem resistant Enterobacteriaceae (CRE), extreme drug resistant Pseudomonas aeruginosa, pan drug resistant  Pseudomonas aeruginosa
  • Multidrug resistant Mycobacterium tuberculosis
  • Multidrug resistant fungus such as Candida auris
Apart from drug resistant Streptococcus pneumoniae and tuberculosis which is often acquired from the community, infections with MDROs are much more common in the healthcare setting. These MDROs can affect any system of the body. Common types of MDRO infections include pnuemonia, urinary tract infections, intra-abdominal infections associated with recent surgery / procedures, bloodstream infections and medical device associated infections. 

Infections with multidrug resistant organisms (MDROs) - Symptoms

Patients who develop infections from drug resistant organisms experience the same clinical symptoms as those with drug sensitive organisms.
Common signs and symptoms of infection include fever, chills, lethargy, malaise, headache, cough, dysuria, pain, pus discharge and wound breakdown.

It is only possible to confirm infections with MDROs after microbiological tests are performed. 

Infections with multidrug resistant organisms (MDROs) - How to prevent?

To prevent infections with MDROs, the following measures are important.

Infection control practices
Good infection control practices such as hand hygiene (handwashing with soap and water or the use of alcohol-based hand disinfectant), the donning of protective equipment (gowns and gloves) and isolation precautions (nursing the patient with MDROs in single or cohort rooms) prevents the transmission of MDROs in the healthcare setting. 

Antibiotic Stewardship
Judicious and appropriate use of antibiotics is important. Right drug, right dose, right route of administration for infections improves outcomes of infections. When the infection has resolved, antibiotic use should be promptly discontinued.
Unnecessary and inappropriate use of antibiotics breeds resistance and makes them less effective in the future. Also, antibiotics should not be used to treat viral infections; instead, they should be symptomatically managed. 

The hospital leadership is committed to the prevention of infections with MDROs and have set up infrastructure and systems in place to reduce infections with MDROs. 

Infections with multidrug resistant organisms (MDROs) - Causes and Risk Factors

Risk factors for the acquisition of MDROs include:
  • Certain chronic medical conditions, e.g. end stage renal failure, chronic lung disease, end stage liver disease
  • Underlying malignancy (hematology and oncology patients)
  • Transplant recipients
  • Presence of in-dwelling medical devices such as urinary catheters, endotracheal tubes, central venous catheter, dialysis catheter
  • Recent surgery or endoscopic procedures
  • Recent receipt of broad-spectrum antibiotics
  • Admission to the intensive care unit
  • Prolonged hospitalisation
  • Recent admission or repeat attendances at healthcare facilities

Infections with multidrug resistant organisms (MDROs) - Diagnosis

​Blood or body fluid (urine, sputum, respiratory fluid, pleural fluid, abdominal fluid, cerebrospinal fluid, tissue, rectal swabs) are sent for microbiological cultures or molecular tests to confirm the presence of MDROs. 

Infections with multidrug resistant organisms (MDROs) - Treatments

To successfully treat infections with MDROs, source control is crucial.  Infected tissue or device needs to be debrided / removed. Appropriate and timely dosing of active antibiotics is also important. Unfortunately, antibiotic options are often limited. Available active antibiotic agents may be toxic. New drugs which are in development for the purpose of treatment of MDROs are either not available or extremely costly. 

Selection of a suitable antibiotic regimen is often made in consult with an experienced team of infectious diseases physicians, specialist pharmacists  in infectious diseases and microbiologist. Recommended treatment regimen is often individualised.


Infections with multidrug resistant organisms (MDROs) - Preparing for surgery

Infections with multidrug resistant organisms (MDROs) - Post-surgery care

Infections with multidrug resistant organisms (MDROs) - Other Information

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