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Information about Multidrug-Resistant Gram-Negative Organisms (MDRGNO)
MDRGNO are a family of Gram-negative bacteria that differ in characteristics but have one thing in common: they are resistant to three or more antibiotics. They include bacteria such as E. coli, Acinetobacter baumannii and bacteria-producing extended spectrum beta-lactamase (ESBL).
These organisms can be part of the normal bacteria in the body and can live happily in the gut or on the skin – this is called ‘colonisation’. MDRGNO are the most common causes of many infections, including urinary tract infections, bloodstream infections and wound infections, all of which can be life-threatening.
Why does antibiotic-resistance matter?
Resistant bacteria often occur where lots of antibiotics are used, which is why they have been identified as an increasing problem in healthcare. These multidrug-resistant organisms are capable of serious, life-threatening infections that are difficult to manage due to limited treatment options.
Replacement treatments can be considered more toxic and costly and can need longer to work effectively. This may mean longer hospital admissions and further complications.
Due to the lack of new antibiotics being developed, it is very important that the antibiotics available for use are preserved and are prescribed and used responsibly.
How are MDRGNO spread?
MDRGNO are most commonly spread through direct contact with the patient or indirectly from the patient's care environment (including equipment). Consistently applying Standard Infection Control Precautions and transmission-based precautions, specifically contact transmission-based precautions, is required to prevent the spread of MDRGNO.
How do we know which patients to screen?
Active screening in high-risk specialties (such as intensive care units) is recommended. Patients that are in a high-risk category should also be considered for screening, including the following.
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Patients who have been inpatients in a hospital abroad in the past 12 months.
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Patients who have been in a UK hospital where MDRGNO are considered endemic in the past 12 months.
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Patients who have previously been infected or colonised with an MDRGNO in the past 12 months.
Patients identified as high risk should be screened and isolated in a single room until the results of the test are known.
Managing patients with confirmed or suspected MDRGNO
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How should patients colonised or infected with an MDRGNO be managed?
In hospital
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You should apply standard infection control precautions and contact transmission-based precautions.
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Patients colonised or infected with MDRGNO should be isolated in a single room, preferably en-suite, and screened every week (unless the clinical care team says otherwise). The Infection Control Team will tell you if any further precautions are necessary. Patients who are colonised do not need to be treated unless advised by the clinical care team. If an infection is confirmed, the clinical team and the infection control doctor must discuss the most appropriate antimicrobial treatment.
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If the patient needs to be transferred to another ward, unit or hospital, you should tell that ward, unit or hospital the patient's MDRGNO status.
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You should provide information leaflets for the patient and their relatives and discuss the leaflets with them.
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Advise relatives and visitors to wash their hands before entering and leaving the patient's room. They do not have to wear personal protective equipment.
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If the patient is readmitted from a community setting, you must apply standard infection control precautions and transmission-based precautions.
In the community
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You must apply standard infection control precautions.
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You do not need to make patients with an MDRGNO your last scheduled home visit, as standard infection control precautions are enough to prevent the spread of infection.
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Patients in the community do not need to be screened weekly for MDRGNO.
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Crockery, cutlery and so on can be washed as normal.
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Clothes and bed linen can be washed as normal at the hottest temperature suitable for the fabric. If laundry is soiled, it should be washed separately, preferably at 60°C.
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There are no restrictions for visitors, but they should be encouraged to wash their hands with soap and water before entering and leaving the patient's room.
Staff concerns
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Can I still care for a patient who has an MDRGNO if I am pregnant?
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There is no extra risk to healthcare workers who are pregnant, but if you have any concerns contact your Iocal Occupational Health Department or Infection Control Team.
I have cared for a patient with a suspected or confirmed MDRGNO. Should I be tested?
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There is no need for you to be tested for MDRGNO, unless your Infection Control Team or Occupational Health Team requests it.
Further information
You can get further advice from the local Infection Prevention and Control Team or Health Protection Team.
This leaflet has been produced by a working party led by Health Protection Scotland on behalf of the joint societies – British Infection Association (BIA), British Society for Antimicrobial Chemotherapy (BSAC), Infection Prevention Society (IPS) and Healthcare Infection Society (HIS).
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