Multi-Drug Resistant Organisms

Most susceptible to MDRO transmission and infection

- coronary artery bypass grafting - total joint replacements - spine surgery - burns - cardiac or urinary catheterization - abdominal or pelvic surgery - organ transplants - brain surgery - compromised immune systems - history of steroid use

Most at risk for VRE

- dialysis - organ transplants - cancer - cardiac, central intravenous, or urinary catheterization - prior exposure to beta-lactam antibiotics - abdominal, brain, or pelvic surgery

Signs/symptoms of VRE

- erythema - drainage or pain at site of infection - patient reports of increased fatigue, fever, nausea, or vomiting

Signs of MRSA infection

- erythema - edema - drainage or pain at infection site - sty if infection is near eye

Symptoms of MRSA infection

- fever - chills - low blood pressure - reports of severe headache - shortness of breath - rash - pustules, boils, abscesses, carbuncles, cellulitis, or impetigo

Most at risk for MRSA infection

- immune compromised - 65 or older - male - African-American - burn patients - associated with patients who have had surgery, dialysis, cardiac or urinary catheterization

MRSA infection

- leading cause of both nosocomial pneumonia and surgical site pneumonia - second-leading cause of nosocomial bloodstream infection

VRE infection

- leading cause of urinary tract infections, bacteremia, wound infections, and endocarditis - contributes to pelvic and abdominal infection, meningitis, and otitis media

MRSA

- methicillin-resistant staphylococcus aureus - (community-asociated MRSA) is the most commonly reported superbug - 86% of invasive infections related to hkospitalization or visit to health care practitioner - can inhabit the dermis and the nares of asymptomatic individuals for weeks or even years - data suggests that increases in hospital-related MRSA are related to increases in community-associated MRSA

MDRO

- multi-drug resistant organism - superbug - affecting different groups now (ie., school-aged children and professional athletes) - CDC defines a superbug as a microorganism, predominantly bacteria, that is resistant to one or more classes of antimicrobial agents - more commonly affect patients in the pediatric and geriatric populations - increase morbidity and mortality - two of the most common MDROs are methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE )

VRE

- vancomycin-resistant enterococci - commonly found in the digestive and urinary tracts of asymptomatic individuals

Environment for superbug

-non-adherence with antibiotic regimens - over medication - keeping unused medication for a later date - not following medical advice upon discharge can spread the bacteria to friends and family

How antibiotics destroy bacteria

1. bactericidal effect where they kill the bacteria outright 2. bacteriostatic effect when they bind to and disrupt the machinery that builds protein and amino acids for bacteria; proteins are needed to manufacture new bacteria in order to replace the dying bacteria 3. altering or rupturing the bacterial cell wall structure by forcing fluids through the cell wall 4. interfering with DNA synthesis by upsetting the production of new chromosomes

Five C's of spreading MDRO's

1. crowding 2. compromised skin 3. frequent skin contact between individuals 4. contaminated surfaces or items 5. lack of cleanliness

How bacteria develop resistance

1. preventing antibiotics from reaching their destined target 2. changing the target 3. destroying the antibiotic outright 4. mutation (i .e., spontaneous mutation, transformation, or plasmid transfer)