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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− | * |
+ | * Generally includes the following bacteria: |
** Gram-positives |
** Gram-positives |
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*** [[MRSA]] |
*** [[MRSA]] |
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*** [[Burkholderia cepacia]] |
*** [[Burkholderia cepacia]] |
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*** [[Ralstonia pickettii]] |
*** [[Ralstonia pickettii]] |
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+ | |||
+ | === European CDC Definitions === |
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+ | |||
+ | * 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 |
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+ | * Multidrug resistant (MDR) is non-susceptible to at least 1 agent in at least 3 categories |
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+ | ** For [[Staphylococcus aureus]], it automatically includes MRSA, but requires resistance in >3 categories |
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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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+ | * Pan-drug resistant (PDR) is non-susceptible to all listed agents |
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+ | * For species with intrinsic resistance to a category or agent, it should be excluded before counting |
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+ | |||
+ | {| class="wikitable" |
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+ | !Category |
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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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+ | | |
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+ | |- |
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+ | |Ansamycins |
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+ | |[[rifampin]] |
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+ | | |
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+ | |- |
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+ | |Anti-MRSA cephalosporins |
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+ | |[[ceftaroline]] |
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+ | | |
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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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+ | |- |
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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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+ | | |
||
+ | |- |
||
+ | |Glycopeptides |
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+ | |[[vancomycin]], [[teicoplanin]], [[telavancin]] |
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+ | | |
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+ | |- |
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+ | |Glycylcyclines |
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+ | |[[tigecycline]] |
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+ | | |
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+ | |- |
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+ | |Lincosamides |
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+ | |[[clindamycin]] |
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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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+ | |Macrolides |
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+ | |[[erythromycin]] |
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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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+ | |Phenicols |
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+ | |[[chloramphenicol]] |
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+ | | |
||
+ | |- |
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+ | |Phosphonic acids |
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+ | |[[fosfomycin]] |
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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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+ | |- |
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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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+ | |- |
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+ | |Streptomycin |
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+ | |[[streptomycin]] (high level) |
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+ | | |
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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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+ | |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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+ | | |
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+ | |- |
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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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+ | |- |
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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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+ | |Folate antagonists |
||
+ | |[[TMP-SMX]] |
||
+ | | |
||
+ | |- |
||
+ | |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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+ | |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 |
||
+ | |[[chloramphenicol]] |
||
+ | | |
||
+ | |- |
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+ | |Phosphonic acid |
||
+ | |[[fosfomycin]] |
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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]] |
||
+ | |- |
||
+ | | rowspan="2" |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]] |
||
+ | |- |
||
+ | ! colspan="3" |[[Pseudomonas aeruginosa]] |
||
+ | |- |
||
+ | |Aminoglycosides |
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+ | |[[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]] |
||
+ | | |
||
+ | |- |
||
+ | ! colspan="3" |[[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]] |
||
+ | | |
||
+ | |} |
Revision as of 17:04, 2 October 2022
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
- Generally includes the following bacteria:
- Gram-positives
- MRSA
- VRE
- Multidrug-resistant Streptococcus pneumoniae
- Gram-negatives:
- Gram-positives
European CDC Definitions
- Defined by the European CDC[1] 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
- ↑ 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.