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multidrug-resistance

Epidemiology: - prevalence of multidrug-resistant (MDR) organisms in hospitalized patients - 2012-2017 prevalence of 4 MDR organisms declined [3] - methicillin-resistant Staphylococcus aureus (MRSA) - vancomycin-resistant Enterococcus (VRE) - MDR Pseudomonas aeruginosa - carbapenem-resistant Acinetobacter - 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 - in 2017 83% of MDR organism were community-acquired [3] - 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.

Related

P-glycoprotein (gp170) or multidrug-resistance glycoprotein

Specific

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

General

drug resistance

References

  1. 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: 19035777
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018.
  3. 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: 32242356 https://www.nejm.org/doi/10.1056/NEJMoa1914433
  4. 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: 33938320
  5. 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: 34269807 Free article. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781966
  6. 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: 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: 34292928 Free article https://www.cdc.gov/mmwr/volumes/70/wr/mm7029a2.htm
  7. Harris AD et al. Prevalence of Acinetobacter baumannii and Candida auris in patients receiving mechanical ventilation. JAMA 2023 Oct 12; [e-pub] PMID: 37824710 JAMA. Published online October 12, 2023