Multi-Drug Resistant Organisms (MRSA, VRE):

Definition/Etiology:

Multi-drug Resistant Organisms (MDROs) are defined as microorganisms, predominantly bacteria, that are resistant to 1 or more classes of antimicrobial agents.

(MDROs) are organisms or microbes that have become resistant to multiple types of drugs that are normally used to treat them. The etiology is basically the over-prescription of antibiotics to treat infections that may not have needed it, thereby causing mutation and resistance to those medications.

Pathophysiology:

Inappropriate use of antibiotics is a primary cause of antibiotic resistance. For example, upper respiratory tract infections and bronchitis are usually caused by viruses. Despite this, approximately 50% of upper respiratory tract infections and 80% of acute bronchitis are inappropriately treated with antibiotics, drugs that only treat infections caused by bacteria. This has contributed to the rise in antibiotic-resistant bacteria. When antibiotics are used inappropriately, they can also kill good bacteria that protect the body from infections with bacteria that make you sick. This can allow bacteria that are drug resistant to grow and multiply.

Clinical Presentation:

The clinical presentation of an MRDO is dependent on the diagnosis. You can have MRDOs with respiratory illnesses, genitourinary illnesses, really anything. The signs and symptoms will be specific to the diagnosis rather than the MRDO.

How we determine if it’s an MRDO is with lab work, be it swabs, or cultures or blood or urine. It’s not until we get results that we will actually know if we are dealing with an established MRDO or the patient has a newly contracted one.

Collaborative Management:

The management of MRDOs is based around treating the symptoms and finding the right medication regimen. Labs will serve a big part here. On top of treatment, a top priority is prevention of transmission. This gets down to basic hygiene and PPE.

Evaluation | Patient Monitoring | Education:

Evaluation of these patients is about reduction of symptoms. In terms of eliminating the infection, it is not actually that easy. Think about it. Vancomycin is one of our most powerful broad-spectrum antibiotics right. Now we have VRE…vanco resistant enterococci. So, we can’t use our superhero antibiotic to treat this. So now how do we treat it? You can see how this could be difficult to cure.

Many of these patients will be discharged from the hospital or the ER and still have an MRDO. The important educational point with them is stressing the fact that they can spread it. Proper hygiene is key. Many of these patients come from the nursing home community and we need to make sure that when they return, that the staff knows which MRDO the patient may have and what precautions to take.

Linchpins: (Key Points)

• PPE
• Symptoms Mgmt