Multidrug-resistant organism: Difference between revisions
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(Created page with "== Background == * Microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents * Definition varies from hospital to hospital or country to country * Includes the following bacteria: ** Gram-positives *** MRSA *** VRE *** Multidrug-resistant Streptococcus pneumoniae ** Gram-negatives: *** ESBL and CPE *** Acinetobacter baumannii complex *** Stenotrophomonas maltophilia *** Burkholderia cepacia ***...") |
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* Definition varies from hospital to hospital or country to country |
* Definition varies from hospital to hospital or country to country |
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=== European CDC Definitions === |
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* Includes the following bacteria: |
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** Gram-positives |
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* Defined by the European CDC[[CiteRef::magiorakos2012mu]] as non-susceptibility to at least one agent in three or more categories of antimicrobials, with the categories varying by organism |
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*** [[MRSA]] |
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* Multidrug resistant (MDR) is non-susceptible to at least 1 agent in at least 3 categories |
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*** [[VRE]] |
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** For [[Staphylococcus aureus]], it automatically includes MRSA, but requires resistance in >3 categories |
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*** Multidrug-resistant [[Streptococcus pneumoniae]] |
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* Extensively drug-resistant (XDR) is non-susceptible to at least 1 agent in all but 2 categories |
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** Gram-negatives: |
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* Pan-drug resistant (PDR) is non-susceptible to all listed agents |
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*** [[ESBL]] and CPE |
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* For species with intrinsic resistance to a category or agent, it should be excluded before counting |
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*** [[Acinetobacter baumannii complex]] |
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*** [[Stenotrophomonas maltophilia]] |
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{| class="wikitable" |
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*** [[Burkholderia cepacia]] |
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!Category |
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*** [[Ralstonia pickettii]] |
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!Agent |
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!Species With Intrinsic Resistance |
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|- |
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! colspan="3" |[[Staphylococcus aureus]] |
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|- |
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|Aminoglycocides |
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|gentamicin |
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|Ansamycins |
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|[[rifampin]] |
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|- |
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|Anti-MRSA cephalosporins |
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|[[ceftaroline]] |
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|- |
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|Anti-staphylococcal β-lactams |
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|[[oxacillin]] or [[cefoxitin]] |
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|- |
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|Fluoroquinolones |
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|[[ciprofloxacin]] or [[moxifloxacin]] |
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|- |
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|Folate antagonists |
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|[[TMP-SMX]] |
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|- |
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|Fucidanes |
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|[[fusidic acid]] |
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|- |
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|Glycopeptides |
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|[[vancomycin]], [[teicoplanin]], [[telavancin]] |
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|- |
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|Glycylcyclines |
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|[[tigecycline]] |
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|- |
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|Lincosamides |
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|[[clindamycin]] |
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|- |
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|Lipopeptides |
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|[[daptomycin]] |
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|- |
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|Macrolides |
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|[[erythromycin]] |
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|- |
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|Oxazolidinones |
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|[[linezolid]] |
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|- |
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|Phenicols |
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|[[chloramphenicol]] |
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| |
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|- |
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|Phosphonic acids |
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|[[fosfomycin]] |
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| |
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|- |
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|Streptogramins |
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|[[quinupristin-dalfopristin]] |
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| |
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|- |
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|Tetracyclines |
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|[[tetracycline]], [[doxycycline]], [[minocycline]] |
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|- |
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! colspan="3" |[[Enterococcus]] |
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|- |
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|Aminoglycosides, except streptomycin |
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|[[gentamicin]] (high level) |
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|- |
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|Streptomycin |
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|[[streptomycin]] (high level) |
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|- |
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|Carbapenems |
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|[[imipenem]], [[meropenem]], [[doripenem]] |
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|[[Enterococcus faecium]] |
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|- |
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|Fluoroquinolones |
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|[[ciprofloxacin]], [[levofloxacin]], [[moxifloxacin]] |
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| |
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|- |
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|Glycopepties |
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|[[vancomycin]], [[teicoplanin]] |
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| |
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|- |
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|Glycyclcyclines |
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|[[tigecycline]] |
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| |
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|- |
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|Lipopeptides |
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|[[daptomycin]] |
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| |
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|- |
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|Oxazolidinones |
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|[[linezolid]] |
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| |
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|- |
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|Penicillins |
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|[[ampicillin]] |
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| |
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|- |
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|Streptogramins |
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|[[quinupristin-dalfopristin]] |
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|[[Enterococcus faecalis]] |
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|- |
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|Tetracyclines |
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|[[doxycycline]], [[minocycline]] |
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! colspan="3" |[[Enterobacterales]] |
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|- |
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| rowspan="2" |Aminoglycosides |
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|[[gentamicin]], [[tobramycin]], [[netilmicin]] |
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|[[Providencia rettgeri]], [[Providencia stuartii]] |
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|- |
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|[[tobramycin]] |
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|[[Providencia rettgeri]], [[Providencia stuartii]] |
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|- |
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|Anti-MRSA cephalosporins |
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|[[ceftaroline]] |
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|only approved for [[Escherichia coli]], [[Klebsiella pneumoniae]], [[Klebsiella oxytoca]] |
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|- |
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|Antipseudomonal penicillins with β-lactamase inhibitors |
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|[[ticarcillin-clavulanic acid]], [[piperacillin-tazobactam]] |
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|[[Escherichia hermannii]] |
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|- |
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|Carbapenems |
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|[[ertapenem]], [[imipenem]], [[meropenem]], [[doripenem]] |
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|- |
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| rowspan="2" |1st & 2nd generation cephalosporins |
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|[[cefazolin]] |
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|[[Citrobacter freundii]], [[Klebsiella aerogenes]], [[Enterobacter cloacae]], [[Hafnia alvei]], [[Morganella morganii]], [[Proteus penneri]], [[Proteus vulgaris]], [[Providencia rettgeri]], [[Providencia stuartii]], [[Serratia marcescens]] |
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|- |
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|[[cefuroxime]] |
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|[[Morganella morganii]], [[Providencia penneri]], [[Providencia vulgaris]], [[Serratia marcescens]] |
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|- |
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|3rd & 4th generation cephalosporins |
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|[[cefotaxime]] or [[ceftriaxone]], [[ceftazidime]], [[cefepime]] |
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| |
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|- |
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|Cephamycins |
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|[[cefoxitin]], [[cefotetan]] |
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|[[Citrobacter freundii]], [[Klebsiella aerogenes]], [[Enterobacter cloacae]], [[Hafnia alvei]] |
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|- |
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|Fluoroquinolones |
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|[[ciprofloxacin]] |
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| |
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|- |
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|Folate antagonists |
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|[[TMP-SMX]] |
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| |
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|- |
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|Glycylcyclines |
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|[[tigecycline]] |
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|[[Morganella morganii]], [[Proteus mirabilis]], [[Providencia penneri]], [[Providencia vulgaris]], [[Providencia rettgeri]], [[Providencia stuartii]] |
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|- |
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|Monobactams |
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|[[aztreonam]] |
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| |
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|- |
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|Penicillins |
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|[[ampicillin]] |
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|[[Citrobacter koseri]], [[Citrobacter freundii]], [[Klebsiella aerogenes]], [[Enterobacter cloacae]], [[Enterobacter hermanii]], [[Hafnia alvei]], [[Klebsiellae]] spp., [[Morganella morganii]], [[Providencia penneri]], [[Providencia vulgaris]], [[Providencia rettgeri]], [[Providencia stuartii]], [[Serratia marcescens]] |
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|- |
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| rowspan="2" |Penicillins plus β-lactamase inhibitors |
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|[[amoxicillin-clavulanic acid]] |
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|[[Citrobacter freundii]], [[Klebsiella aerogenes]], [[Enterobacter cloacae]], [[Hafnia alvei]], [[Morganella morganii]], [[Providencia rettgeri]], [[Providencia stuartii]], [[Serratia marcescens]] |
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|- |
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|[[ampicillin-sulbactam]] |
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|[[Citrobacter freundii]], [[Citrobacter koseri]], [[Klebsiella aerogenes]], [[Enterobacter cloacae]], [[Hafnia alvei]], [[Providencia rettgeri]], [[Serratia marcescens]] |
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|- |
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|Phenicols |
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|[[chloramphenicol]] |
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| |
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|- |
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|Phosphonic acid |
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|[[fosfomycin]] |
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| |
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|- |
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|Polymyxins |
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|[[colistin]] |
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|[[Morganella morganii]], [[Proteus mirabilis]], [[Providencia penneri]], [[Providencia rettgeri]], [[Providencia stuartii]], [[Serratia marcescens]] |
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|- |
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| rowspan="2" |Tetracyclines |
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|[[tetracycline]] |
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|[[Morganella morganii]], [[Proteus mirabilis]], [[Providencia penneri]], [[Providencia vulgaris]], [[Providencia rettgeri]], [[Providencia stuartii]], |
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|- |
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|[[doxycycline]], [[minocycline]] |
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|[[Morganella morganii]], [[Providencia penneri]], [[Providencia vulgaris]], [[Providencia rettgeri]], [[Providencia stuartii]] |
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|- |
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! colspan="3" |[[Pseudomonas aeruginosa]] |
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|- |
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|Aminoglycosides |
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|[[gentamicin]], [[tobramycin]], [[amikacin]], [[netilmicin]] |
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| |
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|- |
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|Antipseudomonal carbapenems |
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|[[imipenem]], [[meropenem]], [[doripenem]] |
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| |
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|- |
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|Antipseudomonal cephalosporins |
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|[[ceftazidime]], [[cefepime]] |
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| |
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|- |
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|Antipseudomonal fluoroquinolones |
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|[[ciprofloxacin]], [[levofloxacin]] |
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| |
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|- |
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|Antipseudomonal penicillins plus β-lactamase inhibitors |
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|[[ticarcillin-clavulanic acid]], [[piperacillin-tazobactam]] |
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| |
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|- |
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|Monobactams |
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|[[aztreonam]] |
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| |
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|- |
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|Phosphonic acids |
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|[[fosfomycin]] |
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| |
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|- |
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|Polymyxins |
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|[[colistin]], [[polymyxin B]] |
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| |
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|- |
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! colspan="3" |[[Acinetobacter]] |
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|- |
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|Aminoglycosides |
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|[[gentamicin]], [[tobramycin]], [[amikacin]], [[netilmicin]] |
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| |
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|- |
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|Antipseudomonal carbapenems |
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|[[imipenem]], [[meropenem]], [[doripenem]] |
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| |
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|- |
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|Antipseudomonal fluoroquinolones |
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|[[ciprofloxacin]], [[levofloxacin]] |
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| |
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|- |
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|Antipseudomonal penicillins plus β-lactamase inhibitors |
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|[[ticarcillin-clavulanic acid]], [[piperacillin-tazobactam]] |
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| |
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|- |
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|Extended-spectrum cephalosporins |
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|[[ceftriaxone]], [[ceftazidime]], [[cefepime]] |
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| |
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|- |
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|Folate antagonists |
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|[[TMP-SMX]] |
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| |
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|- |
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|Phosphonic acids |
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|[[fosfomycin]] |
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| |
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|- |
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|Penicillins plus β-lactamase inhibitors |
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|[[ampicillin-sulbactam]] |
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| |
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|- |
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|Polymyxins |
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|[[colistin]], [[polymyxin B]] |
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| |
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|- |
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|Tetracyclines |
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|[[tetracycline]], [[doxycycline]], [[minocycline]] |
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| |
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|} |
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Latest revision as of 17:08, 27 September 2024
Background
- Microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents
- Definition varies from hospital to hospital or country to country
European CDC Definitions
- Defined by the European CDC1 as non-susceptibility to at least one agent in three or more categories of antimicrobials, with the categories varying by organism
- Multidrug resistant (MDR) is non-susceptible to at least 1 agent in at least 3 categories
- For Staphylococcus aureus, it automatically includes MRSA, but requires resistance in >3 categories
- Extensively drug-resistant (XDR) is non-susceptible to at least 1 agent in all but 2 categories
- Pan-drug resistant (PDR) is non-susceptible to all listed agents
- For species with intrinsic resistance to a category or agent, it should be excluded before counting
References
- ^ A.-P. Magiorakos, A. Srinivasan, R.B. Carey, Y. Carmeli, M.E. Falagas, C.G. Giske, S. Harbarth, J.F. Hindler, G. Kahlmeter, B. Olsson-Liljequist, D.L. Paterson, L.B. Rice, J. Stelling, M.J. Struelens, A. Vatopoulos, J.T. Weber, D.L. Monnet. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical Microbiology and Infection. 2012;18(3):268-281. doi:10.1111/j.1469-0691.2011.03570.x.
