Multidrug-resistant organisms MRO: infection prevention and control (IPC) principles

Multidrug resistant organism (MROs) are resistant to multiple classes of antimicrobial agents and can be associated with increased morbidity and mortality.

Antimicrobial resistance (AMR) amongst microorganisms that can cause infections in healthcare settings is an issue of concern. Refer to the National Alert System for Critical Antimicrobial Resistances (CARAlert) web page for further information about priority organisms with critical resistances to last-line antimicrobials.

Infections with MROs can be difficult to treat and can be associated with poorer outcomes for patients and increased costs to the health care system.

What causes AMR?

AMR occurs naturally when microorganisms change to protect themselves from being injured or killed by antimicrobials.  The use of antimicrobials is necessary in care and treatment of patients, however guidelines recommend good antimicrobial stewardship that promotes the correct and safe use of antimicrobials/antibiotics. 

AMR microorganisms and healthcare facilities 

AMR microorganisms that may affect patients in health care facilities include: 

  • Methicillin-resistant Staphylococcus aureus (MRSA) — responsible for up to a third of healthcare associated bloodstream infections.
  • Vancomycin-resistant enterococci (VRE)
  • Linezolid-resistant enterococci (LRE) and Linezolid-resistant Vancomycin-resistant enterococci (LRVRE) 
  • Multi-resistant Gram-negative bacteria (MRGN), including:
    • Carbapenemase-producing resistant Enterobacterales (CPE), which is an emerging resistance of concern and is a notifiable disease in South Australia.
    • Extended-spectrum beta-lactamases (ESBL) — transferable resistance to 3rd and 4th generation cephalosporins, mostly found in E.coli, Klebsiella and Enterobacter species.
    • Metallo-beta-lactamases (MBL) — similar to ESBL, but can also include resistance to carbapenems, mostly found in Pseudomonas aeruginosa.
    • Carbapenemase-producing organisms such as Pseudomonas aeruginosa and Acinetobacter baumannii.
    • Plasmid medicated AMP-C
    • Candida auris (C.auris) is a multi-drug resistant fungus (yeast) that can cause serious infections and is a notifiable disease in South Australia.
    • In Australia, organisms such as C.auris, CPE and CPOs are Critical Antimicrobial Resistant  (CAR) Alert organisms.

Infection prevention and control

The minimisation of the risk, prevention and control of infection and/or colonisation with AMR microorganisms generally involves the simultaneous application of a number of strategies including:

Patient management

Hospitals and healthcare settings should have strategies, policies and procedures for the management of MRO colonisation and infection, with practices adapted to suit the clinical setting.

A patient/resident's MRO status must not interfere with the provision of appropriate care. No person in South Australia should be refused admission to any healthcare or residential care facility, or have their health care compromised solely due to being colonised or infected with an MRO.

For further information on the management of patients colonised and infected with MROs in the acute and non-acute care settings, refer to National, SA Health and local facility policies and guidelines including:

National

SA Health

Other resources (Interstate/International)

Public and consumer resources

National

SA Health

Further information

For further information contact SA Health's Infection Control Service on 08 7425 7161

Clinical information in this section