multidrug-resistance
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Epidemiology
- prevalence of multidrug-resistant (MDR) organisms in hospitalized patients
- 2012-2017 prevalence of 4 MDR organisms declined[3]
- no change in carbapenem-resistant Enterobacteriaceae 2012-2017
- increase in extended-spectrum beta-lactamase producing Enterobacteriaceae
- prevalence of multidrug-resistant (MDR) organisms in community is increasing
- 47% of hospitalizations with sepsis from nursing homes are due to multidrug-resistant organisms[4]
- highly-resistant Candida auris often colonizes skin of long-term facility residents[6]
- carbapenem-resistant Acinetobacter baumannii & Candida auris are common among patients receiving mechanical ventilation [7]
- both in acute care hospitals & long-term care facilities
- both more common in long-term care facilities than in acute care hospitals
Mechanism of action
- multidrug-resistance via expression of P-glycoprotein results from chemotherapy
Complications
- treatment of nosocomial infections by multidrug-resistant organisms is complicated by delays in identifying effective therapy
Management
- prevention:
- hand hygiene
- contact precautions are effective[2]
- disinfecting equipment & environment
- judicious use of antimicrobial agents[2]
- chlorhexidine bathing[5]
- chlorhexidine gluconate at concentrations > 625 ug/mL (0.0625%) reduces Candica auris skin colonization[6]
- multidrug-resistant organism surveillance[5]
- health care worker education & feedback[5]
Notes
- verapamil & cyclosporine prevent development of multidrug-resistance in vitro.
More general terms
More specific terms
Additional terms
References
- ↑ Boucher HW, Talbot GH, Bradley JS et al Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jan 1;48(1):1-12. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19035777
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
- ↑ 3.0 3.1 3.2 Jernigan JA, Hatfield KM, Wolford H et al. Multidrug-resistant bacterial infections in U.S. hospitalized patients, 2012-2017. N Engl J Med 2020 Apr 2; 382:1309 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32242356 https://www.nejm.org/doi/10.1056/NEJMoa1914433
- ↑ 4.0 4.1 Tumolo J Multidrug-Resistant Blood Stream Infections Common in NH Residents Hospitalized for Sepsis. Annals of Long-term Care. May 10, 2021 https://www.managedhealthcareconnect.com/annals-long-term-care/multidrug-resistant-blood-stream-infections-common-nh-residents-hospitalized
Aliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital. J Intensive Care Med. 2021 May 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33938320 - ↑ 5.0 5.1 5.2 5.3 Tumolo J Multicomponent Intervention Reduces Microbial Contamination in Nursing Homes. Annals of Long-Term Care. August 13, 2021 https://www.hmpgloballearningnetwork.com/site/altc/news/multicomponent-intervention-reduces-microbial-contamination-nursing-homes
Mody L, Gontjes KJ, Cassone M et al Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes. A Cluster Randomized Clinical Trial. JAMA Netw Open. 2021;4(7):e2116555. July 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34269807 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781966 - ↑ 6.0 6.1 6.2 Proctor DM, Dangana T, Sexton DJ et al. Integrated genomic, epidemiologic investigation of Candida auris skin colonization in a skilled nursing facility. Nat Med 2021 Jun 21; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34155414 https://www.nature.com/articles/s41591-021-01383-w
Lyman M, Forsberg K, Reuben J et al. Notes from the Field: Transmission of pan-resistant and echinocandin-resistant Candida auris in health care facilities - Texas and the District of Columbia, January-April 2021. MMWR Morb Mortal Wkly Rep 2021 Jul 23; 70:1022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34292928 Free article https://www.cdc.gov/mmwr/volumes/70/wr/mm7029a2.htm - ↑ 7.0 7.1 Harris AD et al. Prevalence of Acinetobacter baumannii and Candida auris in patients receiving mechanical ventilation. JAMA 2023 Oct 12; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37824710 JAMA. Published online October 12, 2023