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multidrug-resistant gram-negative bacteria; multidrug-resistant enterobacteriaceae (MRE)

Pharmacology: - resistant to beta-lactams* - often resistant to aminoglycosides & fluoroquinolones * also see extended spectrum beta lactamase (ESBL) Epidemiology: - most prevalent in long-term acute care hospitals [5] - also observed in community - carbapenem-resistant organisms are emerging - carbapenem-resistance (India, Pakistan) conferred by New Delhi metallo-beta-lactamase 1 (emergence in 2010) - increase in multidrug- & carbapenem-resistant Pseudomonas aeruginosa infections in U.S. children 1999-2012 [2] Management: - carbapenem if resistant to resistant to beta-lactams aminoglycosides & fluoroquinolones - colistin if carbapenem-resistant - prevention - antimicrobial stewardship - adhere to hand-hygiene protocols [5] - maintain contact precautions throughout hospitalization after 1st detected [3] - clean & disonfect environment & equipment [5]

Related

extended spectrum beta lactamase (ESBL)

General

gram negative bacteria multidrug-resistance

References

  1. Prescriber's Letter 18(7): 2011 Resistant Gram-negative Bacteria Detail-Document#: 270713 (subscription needed) http://www.prescribersletter.com
  2. Logan LK, Gandra S, Mandal S et al Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012. J Ped Infect Dis (2016) Published online Nov 16 PMID: 27856730
  3. Banach DB, Bearman G, Barnden M et al Duration of Contact Precautions for Acute-Care Settings. Infection Control & Hospital Epidemiology. Jan 11, 2018 PMID: 29321078 https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56
  4. Cilloniz C, Gabarrus A, Ferrer M et al Community-Acquired Pneumonia Due to Multidrug- and Non-Multidrug- Resistant Pseudomonas aeruginosa. Chest. 2016 Aug;150(2):415-25. PMID: 27060725
  5. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021