Multidrug-resistant organism: Difference between revisions

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=== European CDC Definitions ===
=== European CDC Definitions ===


* Defined by the European CDC<ref>Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. ''Clin Microbiol Infect''. 2012 Mar;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x. Epub 2011 Jul 27. PMID: 21793988.</ref> as non-susceptibility to at least one agent in three or more categories of antimicrobials, with the categories varying by organism
* 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
* Multidrug resistant (MDR) is non-susceptible to at least 1 agent in at least 3 categories
* 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
** For [[Staphylococcus aureus]], it automatically includes MRSA, but requires resistance in >3 categories

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
  • 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
Category Agent Species With Intrinsic Resistance
Staphylococcus aureus
Aminoglycocides gentamicin
Ansamycins rifampin
Anti-MRSA cephalosporins ceftaroline
Anti-staphylococcal β-lactams oxacillin or cefoxitin
Fluoroquinolones ciprofloxacin or moxifloxacin
Folate antagonists TMP-SMX
Fucidanes fusidic acid
Glycopeptides vancomycin, teicoplanin, telavancin
Glycylcyclines tigecycline
Lincosamides clindamycin
Lipopeptides daptomycin
Macrolides erythromycin
Oxazolidinones linezolid
Phenicols chloramphenicol
Phosphonic acids fosfomycin
Streptogramins quinupristin-dalfopristin
Tetracyclines tetracycline, doxycycline, minocycline
Enterococcus
Aminoglycosides, except streptomycin gentamicin (high level)
Streptomycin streptomycin (high level)
Carbapenems imipenem, meropenem, doripenem Enterococcus faecium
Fluoroquinolones ciprofloxacin, levofloxacin, moxifloxacin
Glycopepties vancomycin, teicoplanin
Glycyclcyclines tigecycline
Lipopeptides daptomycin
Oxazolidinones linezolid
Penicillins ampicillin
Streptogramins quinupristin-dalfopristin Enterococcus faecalis
Tetracyclines doxycycline, minocycline
Enterobacterales
Aminoglycosides gentamicin, tobramycin, netilmicin Providencia rettgeri, Providencia stuartii
tobramycin Providencia rettgeri, Providencia stuartii
Anti-MRSA cephalosporins ceftaroline only approved for Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca
Antipseudomonal penicillins with β-lactamase inhibitors ticarcillin-clavulanic acid, piperacillin-tazobactam Escherichia hermannii
Carbapenems ertapenem, imipenem, meropenem, doripenem
1st & 2nd generation cephalosporins cefazolin Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Hafnia alvei, Morganella morganii, Proteus penneri, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, Serratia marcescens
cefuroxime Morganella morganii, Providencia penneri, Providencia vulgaris, Serratia marcescens
3rd & 4th generation cephalosporins cefotaxime or ceftriaxone, ceftazidime, cefepime
Cephamycins cefoxitin, cefotetan Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Hafnia alvei
Fluoroquinolones ciprofloxacin
Folate antagonists TMP-SMX
Glycylcyclines tigecycline Morganella morganii, Proteus mirabilis, Providencia penneri, Providencia vulgaris, Providencia rettgeri, Providencia stuartii
Monobactams aztreonam
Penicillins ampicillin 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
Penicillins plus β-lactamase inhibitors amoxicillin-clavulanic acid Citrobacter freundii, Klebsiella aerogenes, Enterobacter cloacae, Hafnia alvei, Morganella morganii, Providencia rettgeri, Providencia stuartii, Serratia marcescens
ampicillin-sulbactam Citrobacter freundii, Citrobacter koseri, Klebsiella aerogenes, Enterobacter cloacae, Hafnia alvei, Providencia rettgeri, Serratia marcescens
Phenicols chloramphenicol
Phosphonic acid fosfomycin
Polymyxins colistin Morganella morganii, Proteus mirabilis, Providencia penneri, Providencia rettgeri, Providencia stuartii, Serratia marcescens
Tetracyclines tetracycline Morganella morganii, Proteus mirabilis, Providencia penneri, Providencia vulgaris, Providencia rettgeri, Providencia stuartii,
doxycycline, minocycline Morganella morganii, Providencia penneri, Providencia vulgaris, Providencia rettgeri, Providencia stuartii
Pseudomonas aeruginosa
Aminoglycosides gentamicin, tobramycin, amikacin, netilmicin
Antipseudomonal carbapenems imipenem, meropenem, doripenem
Antipseudomonal cephalosporins ceftazidime, cefepime
Antipseudomonal fluoroquinolones ciprofloxacin, levofloxacin
Antipseudomonal penicillins plus β-lactamase inhibitors ticarcillin-clavulanic acid, piperacillin-tazobactam
Monobactams aztreonam
Phosphonic acids fosfomycin
Polymyxins colistin, polymyxin B
Acinetobacter
Aminoglycosides gentamicin, tobramycin, amikacin, netilmicin
Antipseudomonal carbapenems imipenem, meropenem, doripenem
Antipseudomonal fluoroquinolones ciprofloxacin, levofloxacin
Antipseudomonal penicillins plus β-lactamase inhibitors ticarcillin-clavulanic acid, piperacillin-tazobactam
Extended-spectrum cephalosporins ceftriaxone, ceftazidime, cefepime
Folate antagonists TMP-SMX
Phosphonic acids fosfomycin
Penicillins plus β-lactamase inhibitors ampicillin-sulbactam
Polymyxins colistin, polymyxin B
Tetracyclines tetracycline, doxycycline, minocycline

References

  1. ^  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.