Infections with multidrug resistant organisms (MDROs)

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:

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. 

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. 

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

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. 

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. 

Risk factors for the acquisition of MDROs include:

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.