Multidrug-Resistant Organisms (MDROs)

Some bacteria have become resistant to the antibiotics used to treat them. This means the antibiotics can no longer kill those germs. Bacteria that resist treatment with more than one antibiotic are called multidrug-resistant organisms (MDROs). MDROs mainly affect people in hospitals and long-term care facilities, but they are also spreading among healthy children and adults. A person may be a carrier or may have the infection.

• Colonization. When a person carries the MDRO bacteria but is healthy, it is called being colonized. This person can spread the MDRO to others but has no symptoms of infection.
• Infection. When a person gets sick because of the bacteria, it is called being infected with the MDRO. This person can also spread the MDRO to others. If not treated properly, MDRO infections can be very serious and even cause death.

What causes MDROs?

MDROs are caused by the misuse of medicines that treat bacterial infections (antibiotics). Misuse is when antibiotics are taken longer than necessary. It also happens when they are not taken long enough, or taken when they are not needed. At first, only a few bacteria may survive treatment with an antibiotic but the more often antibiotics are used, the more likely it is that resistant bacteria will develop.

What are the risk factors for MDROs?

Anyone can be colonized or infected by an MDRO but certain risk factors make this more likely. These include:

• Living with or having close contact with a person who is infected or colonized
• Sharing items with a person who is infected or colonized
• Having a serious illness or weakened immune system
• Recent hospital stay
• Living in a nursing home or long-term care facility
• Antibiotic treatment
• Having medical procedures, such as kidney dialysis
• Having a medical device, such as a tube placed in the bladder to drain urine (urinary catheter)
• Previous MDRO colonization or infection
• Older age

How are MDROs spread?

• People who are colonized with an MDRO often carry the germs on the skin and in the body. These people are not sick but they can spread the MDRO to others.
• In hospitals and long-term care facilities, MDROs are often spread on the hands of healthcare workers. The germs can also spread on objects such as carts, door handles and bed rails.
• Outside healthcare settings, MDRO infections usually spread through skin-to-skin contact, shared towels or athletic equipment or through close contact with an infected person.

How are MDRO infections diagnosed?

The infected area is swabbed or a sample of tissue is taken and sent to the lab. In the lab, the bacteria is identified and tested for resistance to antibiotics.

What types of infections can MDROs cause?

MDROs can cause infections in almost any part of the body including:

• Skin
• Lungs
• Urinary tract
• Bloodstream
• Wounds

How are MDRO infections treated?

MDRO colonization does not usually need treatment but people should do their best to avoid spreading MDRO germs to others. Depending on the type of MDRO a person has, he or she may undergo a process called decolonization. Your healthcare provider will let you know more about this treatment if needed.

MDRO infections can be hard to treat because they do not respond to many common antibiotics. However, some antibiotics are still  effective against MDRO's and are routinely prescribed. Your healthcare provider will test for the type of MDRO causing your illness and will choose the best antibiotic.

Can MDRO infections be prevented?

Hospitals, nursing homes, or long-term care facilities help prevent MDRO infections by doing the following:

• Handwashing. This is the single most important way to prevent the spread of germs. Health care workers should wash their hands with soap and water before and after treating each patient or they should use an alcohol-based hand cleaner if soap and water is not available. They should also clean their hands after touching any surface that may be contaminated and after removing protective clothing. Visitors should also practice handwashing when visiting family or friends in these facilities.
• Protective clothing. Healthcare workers and visitors wear gloves, a gown, and sometimes a mask when they enter the room of a patient with an MDRO. The clothing is removed before leaving the room.
• Careful use of antibiotics. Using antibiotics only when needed and for the shortest time possible helps prevent the growth of more antibiotic-resistant bacteria.
• Private rooms. People with MDRO infections and who have an open wound, a tracheostomy (a surgical hole in help them breathe), or are intubated (have a tube in their throat to help them breathe) will be placed in private room or in a room with others who have the same infection..
• Daily cleaning. All patient care items, equipment, and room surfaces are cleaned and disinfected every day.
• Monitoring. Hospitals monitor the spread of MDROs and educate all staff on the best ways to prevent it.

Patients can help prevent MDRO infections by doing the following:

• Ask all hospital staff to wash their hands before touching you. Do not be afraid to speak up!
• Wash your own hands often with soap and water or use an alcohol-based hand gel.
• Ask that stethoscopes and other instruments be wiped with alcohol before they are used on you.

If you are taking care of someone with an MDRO infection:

• Clean your hands before and after any contact with the person.
• Wear gloves if you might touch body fluids and discard them. Discard the gloves after wearing them and then wash your hands well.
• Wash the person’s bed linen, towels and clothing in hot water with detergent and liquid bleach.
• Clean the person’s room often with a household disinfectant or make your own cleaner. Do this by adding 1/4 cup liquid bleach to 1 gallon of water.

Everyone can help prevent MDRO infections by doing the following:

• Wash your hands often with warm water and soap.
• • Clean the whole hand, under your nails, between your fingers, and up the wrists.
  • Wash for at least 15 to 20 seconds.
  • Rinse, letting the water run down your fingers, not up your wrist.
  • Dry your hands well. Use a paper towel to turn off the faucet and open the door.
• If soap and water are not available, use an alcohol-based hand cleaner.
• • Squeeze about a tablespoon of cleaner into the palm of one hand.
  • Rub your hands together briskly, cleaning the backs of your hands, the palms, between your fingers, and up the wrists.
  • Rub until the cleaner is gone and your hands are completely dry.
• Keep cuts and scrapes clean and covered until they heal.
• Avoid contact with the wounds or bandages of others.
• Avoid sharing towels, razors, clothing, and athletic equipment.