Difference between revisions of "Multidrug-resistant organisms (MDRO)"

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MDRO pathogens that are frequently implicated in severe healthcare-associated infections (HAIs) and have important infection control implications are the following:
  
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* Gram-positive: methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE);
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* Gram-negative: Pseudomonas aeruginosa, Acinetobacter baumanni and Enterobacteriaceae that are resistant to at least one agent in three or more antimicrobial categories (see table) and organisms such as Stenotrophomonas maltophilia and Burkholderia cepacia, that are intrinsically resistant to the broadest-spectrum antimicrobial agents.
  
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Table: Antimicrobial categories used to define MDR gram-negative bacteria.
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{| class="wikitable"
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|- style="font-style:italic; font-weight:bold;"
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! style="vertical-align:bottom;" | Enterobacteriaceae
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! style="vertical-align:bottom;" | Pseudomonas aeruginosa
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! style="vertical-align:bottom;" | Acinetobacter spp
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! style="font-style:normal; font-weight:normal;" |
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! style="font-style:normal; font-weight:normal;" |
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|-
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| style="vertical-align:bottom;" | Aminoglycosides
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| style="vertical-align:bottom;" | Aminoglycosides
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| style="vertical-align:bottom;" | Aminoglycosides
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|
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|
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|-
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| style="vertical-align:bottom;" | Cephalosporins
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| style="vertical-align:bottom;" | Antipseudomonal cephalosporins  (ceftazidime, cefepime)
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| style="vertical-align:bottom;" | Antipseudomonal carbapenems  (Imipenem, Meropenem, Doripenem)
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|
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|
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|-
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| style="vertical-align:bottom;" | Carbapenems  (Ertapenem, Imipenem, Meropenem, Doripenem)
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| style="vertical-align:bottom;" | Antipseudomonal carbapenems  (Imipenem, Meropenem, Doripenem)
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| style="vertical-align:bottom;" | Antipseudomonal fluoroquinolones  (ciprofloxacin, levofloxacin)
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|
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|
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|-
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| style="vertical-align:bottom;" | Antipseudomonal  penicillins + beta-lactamase inhibitors
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| style="vertical-align:bottom;" | Antipseudomonal fluoroquinolones  (ciprofloxacin, levofloxacin)
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| style="vertical-align:bottom;" | Antipseudomonal penicillins +  beta-lactamase inhibitors
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|
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|
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|-
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| style="vertical-align:bottom;" | Fluoroquinolones
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| style="vertical-align:bottom;" | Antipseudomonal penicillins +  beta-lactamase inhibitors (piperacillin/tazobactam, ticarcillin-clavulanic  acid)
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| style="vertical-align:bottom;" | Extended spectrum cephalosporins  (cefotaxime, ceftriaxone, ceftazidime, cefepime)
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|
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|
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|-
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| style="vertical-align:bottom;" | Folate  pathway inhibitors
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| style="vertical-align:bottom;" | Monobactams
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| style="vertical-align:bottom;" | Folate pathway inhibitors
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|
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|
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|-
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| style="vertical-align:bottom;" | Glycylcyclines
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| style="vertical-align:bottom;" | Phosphonic acids
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| style="vertical-align:bottom;" | Penicillins + beta-lactamase  inhibitors (ampicillin/sulbactam)
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|
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|
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|-
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| style="vertical-align:bottom;" | Monobactams
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| style="vertical-align:bottom;" | Polymyxins
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| style="vertical-align:bottom;" | Polymyxins
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|
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|
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|-
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| style="vertical-align:bottom;" | Penicillins
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| style="vertical-align:bottom;" |
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| style="vertical-align:bottom;" | Tetracyclines
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|
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|
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|-
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| style="vertical-align:bottom;" | Phenicols
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| style="vertical-align:bottom;" |
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| style="vertical-align:bottom;" |
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|
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|
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|-
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| style="vertical-align:bottom;" | Phosphonic  acids
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| style="vertical-align:bottom;" |
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| style="vertical-align:bottom;" |
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|
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|
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|-
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| style="vertical-align:bottom;" | Polymyxins
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| style="vertical-align:bottom;" |
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| style="vertical-align:bottom;" |
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|
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|
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|-
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| style="vertical-align:bottom;" | Tetracyclines
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| style="vertical-align:bottom;" |
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| style="vertical-align:bottom;" |
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|
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|
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|}
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=References=
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* Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18:268-81.
 
[[Category:Main pathogens and resistance]]
 
[[Category:Main pathogens and resistance]]

Revision as of 15:05, 23 March 2023

MDRO pathogens that are frequently implicated in severe healthcare-associated infections (HAIs) and have important infection control implications are the following:

  • Gram-positive: methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE);
  • Gram-negative: Pseudomonas aeruginosa, Acinetobacter baumanni and Enterobacteriaceae that are resistant to at least one agent in three or more antimicrobial categories (see table) and organisms such as Stenotrophomonas maltophilia and Burkholderia cepacia, that are intrinsically resistant to the broadest-spectrum antimicrobial agents.

Table: Antimicrobial categories used to define MDR gram-negative bacteria.

Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter spp
Aminoglycosides Aminoglycosides Aminoglycosides
Cephalosporins Antipseudomonal cephalosporins (ceftazidime, cefepime) Antipseudomonal carbapenems (Imipenem, Meropenem, Doripenem)
Carbapenems (Ertapenem, Imipenem, Meropenem, Doripenem) Antipseudomonal carbapenems (Imipenem, Meropenem, Doripenem) Antipseudomonal fluoroquinolones (ciprofloxacin, levofloxacin)
Antipseudomonal penicillins + beta-lactamase inhibitors Antipseudomonal fluoroquinolones (ciprofloxacin, levofloxacin) Antipseudomonal penicillins + beta-lactamase inhibitors
Fluoroquinolones Antipseudomonal penicillins + beta-lactamase inhibitors (piperacillin/tazobactam, ticarcillin-clavulanic acid) Extended spectrum cephalosporins (cefotaxime, ceftriaxone, ceftazidime, cefepime)
Folate pathway inhibitors Monobactams Folate pathway inhibitors
Glycylcyclines Phosphonic acids Penicillins + beta-lactamase inhibitors (ampicillin/sulbactam)
Monobactams Polymyxins Polymyxins
Penicillins Tetracyclines
Phenicols
Phosphonic acids
Polymyxins
Tetracyclines

References

  • Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18:268-81.
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