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Multi-drug Resistant Organisms

Antibiotic prescribing and antibiotic resistance are inextricably linked. High levels of antibiotic prescribing are linked with the emergence of multidrug-resistant organisms (MDROS). The most common multidrug-resistant organisms (MDROs) encountered on a global basis are:

  • Multidrug-resistant Gram-positive, e.g. methicillin-resistant  aureus(MRSA), multi-resistant species of coagulase-negative staphylococcus, vancomycin/glycopeptide-resistant enterococci (VRE/GRE), and penicillin-resistant Streptococci pneumoniae (PRP)
  • Multidrug-resistant Gram-negative (MDRGN), g. extended-spectrum β‎ lactamase (ESBL), carbapenem-resistant/producing Enterobacterales (CRE/CPO) and multi-resistant Pseudomonas spp.
  • Multidrug-resistant tuberculosis
  • Multidrug-resistant Candida spp. esp Candida auris

In healthcare facilities, the prevention of the spread of MDROs is essential for the following reasons:

  • The patient is less likely to respond to the first or second line of empirical antibiotic therapy
  • Patients may have to stay longer in the hospital as some antibiotic preparations are available only in IV formulation
  • Inappropriate use of broad-spectrum agents may result not only in the increased incidence of MDROs but also increases the incidence of Clostridioides difficile infections
  • Unavailability of antibiotics to treat MDROs in the near future due to lack of development of newer antimicrobial agents
  • Limited choice in the selection of older ‘tried and tested’ agents which are cheaper and have better understood efficacy and adverse effect profiles
  • Newer agents have restricted licensing conditions limiting their use to certain infections only, due to limited availability of clinical data on their efficacy and adverse effect profiles

To achieve successful control of resistant organisms, a variety of combined interventions are required; these include:

  • Judicious and appropriate use of antibiotics, antifungal and antiviral agents
  • Hand hygiene improvements
  • Implementation of standard and contact-based precautions
  • Enhanced and increased frequency of environmental cleaning
  • Education of healthcare professionals and the general public
  • Robust surveillance systems to monitor the epidemiology and spread of multidrug-resistant organisms


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