Key points
MDROs continue to be a concern for health and social care settings. Some bacteria are naturally resistant to certain types of antimicrobials, whilst others develop or acquire resistance:
- glycopeptide resistant enterococci (GRE) also known as Vancomycin resistant Enterococci (VRE)
- carbapenemases producing Enterobacterales (CPE)
- extended spectrum beta-lactamase (ESBL) producing organisms, for example, Escherichia coli (E.coli) and Klebsiella species
- multi resistant Acinetobacter species
- multi resistant Pseudomanas species
- any other antimicrobial resistant bacteria
Diagnosis
All the MDROs listed are detected from specimens sent to the laboratory. The patient may have clinical signs of infection for example, diarrhoea, exuding wounds, urinary tract infection, respiratory tract infection.
Transmission
- Most MDROs are spread by contact with an infected person and their excretions or secretions.
- Transmission can also occur via contaminated hands, surfaces or objects.
- MDROs can spread rapidly so effective management of affected patients is essential.
Treatment, colonisation
- No antimicrobial treatment required.
- Colonisation can occur when the organisms are present in areas such as the large bowel or on skin or wounds but are not causing infection.
- Colonisation can lead to infection.
Treatment, infection
- As there may be limited therapeutic options for treatment of MDROs discuss antimicrobial management with the microbiologist.
- Treatment should be guided by laboratory results.
IPC precautions, colonisation
- Standard precautions required.
- Patients colonised with any of the MDROs listed should be placed in a single room but if this is not possible other patients in the bay must not have wounds or invasive devices.
- Patients may come out of their room providing that they are not displaying symptoms, for example, diarrhoea, urinary incontinence.
- Encourage the patient with hand hygiene especially after using the toilet.
IPC precautions, infection
- Transmission based precautions required:
- wear fluid repellent surgical mask and eye protection if risk of contamination to the face or eyes
- wear a long-sleeved fluid repellent gown if there is risk of extensive splashing of blood, body fluids, secretions or excretion onto skin or clothing
- Patients with CPE or VRE who are symptomatic with diarrhoea must be isolated in a single room with en-suite facilities or dedicated commode.
- Risk assessment is required for patients with other MDROs to determine appropriate placement and the need for isolation.
- Use liquid soap and water for hand hygiene.
- Encourage the patient with hand hygiene especially after using the toilet.
- Treat linen as contaminated (red alginate bag) and waste as infections (orange waste bag).
- Twice daily environmental cleaning with chlor-clean (1000 ppm).
- All equipment to be decontaminated thoroughly with Clinell universal wipes.
- Terminal clean of the room required when isolation is discontinued.
- Notify the IPC team of any confirmed inpatient cases:
- Email: rdash.ipcteam@nhs.net
- Telephone: 03000 214872
Swabbing guidance
- Contact screening is required for CPE but not for the other MDROs. Screening is via a rectal swab. Please refer to the Royal Marsden (staff access only) (opens in new window) for the swab procedure.
- No further swabbing required for infected or colonised patients.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025