1 Introduction 1.1 General background Controlling multidrug-resistant organisms (MDROs) is important because MDROs: are resistant to usual antimicrobial therapy increase patient morbidity and mortality add to the cost of treatment have the potential to spread and act as a reservoir of resistance genes for the transmission to other organisms. Since the introduction of antibiotics in the treatment of human infections and use in food animals, there has been ample evidence to show that bacteria can mutate and adapt to survive. Bacteria develop mechanisms to resist the action of antibiotics and in this way become resistant to their use in clinical practice. Certain bacteria seem to develop resistance more readily than others. These bacteria can develop multiresistance to several antibiotics which may severely limit therapeutic choices. The number of MDROs will increase if the selective pressure of antibiotic use continues and the resistant organism is able to spread from one person to another. Therefore the control of antibiotic resistance needs to focus on both: rational antibiotic use to minimise selective pressure the practice of effective infection control measures to prevent the spread of resistant organisms. These Guidelines for the Control of Multidrug-resistant Organisms in provide general advice on MDRO control but focus mainly on those MDROs that are currently considered most important in in terms of emergence and risk of transmission. In particular, they focus on extended-spectrum -lactamase (ESBL)producing organisms and vancomycin-resistant Enterococcus faecium and E. faecalis (VRE). General international resources include the Centers for Disease Control and Prevention (CDC) Management of Multidrug-Resistant Organisms In Healthcare Settings (Siegel D, Rhinehart E, Jackson M, et al 2006 http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf), and other CDC resources for preventing antimicrobial resistance in health care settings available on: http://www.cdc.gov/drugresistance/healthcare/default.htm. The development of these Guidelines for publication has been largely stimulated by concerns over the recent increase in the number of ESBL-producing organisms being isolated in some parts of the country. It is hoped that these Guidelines will facilitate the development of guidelines at the local level. Local practices have to be appropriate to the particular situation, and must take account of the local prevalence of MDROs and the hospital resources that are available.
1 Introduction 1.1 General background Controlling multidrug-resistant organisms (MDROs) is important because MDROs: are resistant to usual antimicrobial therapy increase patient morbidity and mortality add to the cost of treatment have the potential to spread and act as a reservoir of resistance genes for the transmission to other organisms. Since the introduction of antibiotics in the treatment of human infections and use in food animals, there has been ample evidence to show that bacteria can mutate and adapt to survive. Bacteria develop mechanisms to resist the action of antibiotics and in this way become resistant to their use in clinical practice. Certain bacteria seem to develop resistance more readily than others. These bacteria can develop multiresistance to several antibiotics which may severely limit therapeutic choices. The number of MDROs will increase if the selective pressure of antibiotic use continues and the resistant organism is able to spread from one person to another. Therefore the control of antibiotic resistance needs to focus on both: rational antibiotic use to minimise selective pressure the practice of effective infection control measures to prevent the spread of resistant organisms. These Guidelines for the Control of Multidrug-resistant Organisms in provide general advice on MDRO control but focus mainly on those MDROs that are currently considered most important in in terms of emergence and risk of transmission. In particular, they focus on extended-spectrum -lactamase (ESBL)producing organisms and vancomycin-resistant Enterococcus faecium and E. faecalis (VRE). General international resources include the Centers for Disease Control and Prevention (CDC) Management of Multidrug-Resistant Organisms In Healthcare Settings (Siegel D, Rhinehart E, Jackson M, et al 2006 http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf), and other CDC resources for preventing antimicrobial resistance in health care settings available on: http://www.cdc.gov/drugresistance/healthcare/default.htm. The development of these Guidelines for publication has been largely stimulated by concerns over the recent increase in the number of ESBL-producing organisms being isolated in some parts of the country. It is hoped that these Guidelines will facilitate the development of guidelines at the local level. Local practices have to be appropriate to the particular situation, and must take account of the local prevalence of MDROs and the hospital resources that are available.
guidelines-for-control-of-multidrug-resistant-organisms-dec07.docx