Patient education: Multidrug-resistant organisms (The Basics)

What are multidrug-resistant organisms? — Multidrug-resistant organisms ("MDROs") are germs that have learned to outsmart the medicines that doctors normally use to kill them. Doctors call this "resistance."

Most MDROs are bacteria. Normally, bacteria can be killed with antibiotics. But when bacteria become resistant, antibiotics no longer work. Other germs like viruses, parasites, and fungus can also become resistant to the medicines used to kill them.

"Multidrug-resistant" means that a germ is resistant to more than 1 kind of medicine. MDROs can be dangerous because they are harder to kill. This means that the problems they cause are harder to treat.

How does antibiotic resistance happen? — It happens when bacteria that have been exposed to an antibiotic change so that the antibiotic can no longer kill them. With MDROs, the bacteria become resistant to several different antibiotics.

Antibiotic resistance is more likely to happen when:

●People take antibiotics when they don't really need them.

●People do not take antibiotics the right way, or do not take the full course of antibiotics.

●Antibiotics are given to animals raised for food, like chickens or cows, when they are not really needed.

Each of these situations exposes the bacteria to antibiotics. If some bacteria are not killed, they can start to become resistant to the antibiotics. Then, if those bacteria multiply and the same antibiotic is used to treat the infection, it will not work, or it will not work as well. The more often antibiotics are used, the more likely it is that bacteria will become resistant to them.

How do people get infected with an MDRO? — MDROs are common in hospitals and nursing homes. In these places, MDROs have been found on bedrails, telephones, and medical equipment.

MDROs are spread through touch. They are not usually spread through coughing or sneezing. MDROs are often spread by the hands of a person (usually a doctor, nurse, or caregiver) who has touched someone or something with the germ on it. People can also catch an MDRO by touching a surface with the germ on it. In the hospital, these include things like call lights, bedside rails, IV poles, and elevator buttons. Poor handwashing makes it more likely that someone will spread an MDRO to others.

How do I know if I have an MDRO? — Sometimes, people are sick with an infection caused by an MDRO. Other times, a person can have an MDRO inside their body, but not have an infection. This is called being "colonized." A person can be colonized without realizing it. When you are colonized with an MDRO, you can spread the germs to others.

If you have an infection caused by an MDRO, you can also spread the germs to others. You might have symptoms like a fever, chills, or a wound that will not heal. You might have other problems with a wound like swelling, redness, pain, or warmth in the area. You might notice drainage or a foul smell coming from your wound.

Can an infection with an MDRO be treated? — Yes. Your doctor can give you special antibiotics to treat your infection.

●The antibiotics can be given as pills or by "IV." (An IV is a thin tube that goes into a vein.)

●If you get antibiotics to take at home, it is very important to follow the directions exactly. Take all of the pills you are given, even if you feel better before you finish them. If you do not take all of the pills, the bacteria could become resistant to them.

If you are colonized with an MDRO but don't have an infection, you will probably not need antibiotics.

How do health care workers try to prevent infections? — The most important thing they can do is wash their hands often. Doctors and nurses will wash their hands before and after they touch you. If there isn't a sink available, they might use an alcohol-based hand sanitizer instead.

Other things the staff do to prevent spreading infections might include:

●Wearing gowns and gloves when they take care of you

●Placing patients in a separate room or in a room with other patients with the same kind of infection

●Cleaning medical equipment and hospital surfaces with special soaps

●Limiting antibiotics to only when necessary. Overusing antibiotics can cause some germs to become resistant to that type of medicine.

●Teaching patients and visitors about infections and how to prevent them

What can I do to help prevent spreading an infection? — If you are infected or colonized with an MDRO, you can help keep the germs from spreading to others. To do this:

●Wash your hands often with soap and water (figure 1). Scrub your hands for at least 20 seconds and rinse well. Clean your hands after using the toilet and before you eat.

●Take your antibiotics as directed. Finish all of them, even if you are feeling better. This helps keep bacteria from becoming resistant to the antibiotics.

●Keep any cuts, scrapes, or wounds clean and covered until they heal.

●Tell your other health care providers that you have had an infection with an MDRO. They might want to take special precautions to prevent spreading it.

If you are in the hospital or a nursing home:

●Make sure that your doctors and nurses wash their hands before they touch you. If there is no sink, they can use an alcohol-based hand sanitizer instead.

●Ask that stethoscopes and other tools be cleaned with alcohol before they are used on you.

●Stay in your room. Do not go to visitor areas like the hallway or cafeteria. You might need to wear a special hospital gown if you need to leave your room.

●Family and friends who come to visit should wash their hands before and after they come in your room. They might also have to wear a special hospital gown while visiting.

At home:

●Family, friends, and caregivers might want to wash their hands after touching you. This is especially important after touching a wound, using the bathroom or helping a person to use the bathroom, and any time a person cleans the toilet or cleans up a bowel movement. People should also wear gloves and wash their hands before and after touching your medical devices (for example, urinary catheters).

●Change your bedding at least once a week. If it is soiled, wear disposable gloves and change it more often. Try not to touch your clothing when handling the bedding. Wash and dry the bedding in hot water with liquid bleach or laundry soap with bleach in it. If your washing machine reaches temperatures over 130°F or your dryer reaches temperatures over 160°F, you do not need to use bleach. Do not wash or dry bedding with other laundry.

●Clean areas that are touched a lot. Examples include tabletops, sinks, toilets, bathrooms, and bedside commodes. Wipe with a bleach-based cleaner, or make your own by mixing 1/4 cup bleach (60 mL) with 4 cups water (960 mL). Let the bleach solution sit for a few minutes before wiping it off.

●Avoid sharing personal items like towels, razors, or sports equipment.

When should I call the doctor? — Call the doctor or nurse for advice if:

●You have a fever of 100.4°F (38°C) or higher.

●You have diarrhea.

●You develop a new rash.

●You have signs of a skin infection like redness, swelling, warmth, drainage, or pain.

More on this topic

Patient education: What you should know about antibiotics (The Basics)
Patient education: Vancomycin-resistant enterococci (The Basics)
Patient education: Hospital-acquired pneumonia (The Basics)
Patient education: Methicillin-resistant Staphylococcus aureus (MRSA) (The Basics)
Patient education: How to wash your hands (The Basics)

Patient education: Methicillin-resistant Staphylococcus aureus (MRSA) (Beyond the Basics)