Multidrug-Resistant Organisms
Key Points
- MDROs are bacteria resistant to certain antibiotics, making routine treatment less effective.
- Common examples in this source include clostridioides-difficile, methicillin-resistant-staphylococcus-aureus, vancomycin-resistant-enterococci, and multiresistant gram-negative bacilli.
- MDRO-related healthcare-associated-infections are associated with greater severity and complications.
- Antibiotic misuse/overuse and prolonged healthcare exposure increase MDRO risk, especially in older adults.
Pathophysiology
Multidrug-resistant organisms emerge when microbial populations survive antibiotic pressure and develop resistance patterns that reduce treatment response. In healthcare settings, this resistance can propagate through patient-to-patient transmission, equipment contamination, and prolonged exposure environments.
When MDRO infection develops, therapeutic options narrow and illness burden increases. Patients may experience delayed clinical improvement, higher risk for severe complications, and longer care requirements due to reduced antibiotic effectiveness.
Classification
- MDRO definition pattern: Organisms resistant to multiple antimicrobial options.
- Common organism examples: C. difficile, MRSA, VRE, and multiresistant gram-negative bacilli.
- Risk-population context: Older adults have elevated risk due to longer facility exposure, chronic illness burden, and age-related immune decline.
Nursing Assessment
NCLEX Focus
Priority questions emphasize identifying MDRO risk factors and selecting immediate isolation and prevention actions.
- Assess prior and current antibiotic exposure and hospitalization length.
- Evaluate comorbid disease burden and age-related vulnerability factors.
- Identify signs of possible resistant infection despite prior antimicrobial treatment.
- Review culture data promptly (for example MRSA-positive sputum findings) and align precautions.
Nursing Interventions
- Implement and reinforce route-appropriate transmission-based-precautions immediately when indicated.
- Apply strict hand-hygiene and environmental disinfection standards for all contacts.
- Coordinate with interdisciplinary team for culture follow-up and targeted antimicrobial stewardship decisions.
- Educate patient/family on why isolation and antibiotic-use controls are needed.
- Escalate barriers to PPE availability or adherence that threaten infection-control reliability.
Resistance Amplification Risk
Inappropriate antibiotic use and prevention lapses can accelerate MDRO spread and worsen patient outcomes.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Agent choice based on culture/sensitivity | Resistance patterns require targeted selection and avoidance of inappropriate empiric continuation. |
| antimicrobial-stewardship | Facility stewardship framework | Monitor adherence to protocol to reduce unnecessary antibiotic exposure and resistance pressure. |
Clinical Judgment Application
Clinical Scenario
A hospitalized patient has persistent respiratory infection signs despite recent antibiotics, and sputum culture reports MRSA.
Recognize Cues: Ongoing symptoms with culture-confirmed resistant organism. Analyze Cues: Current regimen may not adequately cover resistant pathogen. Prioritize Hypotheses: Immediate priorities are transmission control and targeted treatment alignment. Generate Solutions: Maintain precautions, verify PPE adherence, and coordinate prompt antimicrobial plan adjustment. Take Action: Implement isolation rigor, communicate results, and support updated orders. Evaluate Outcomes: Reduced transmission risk and improving infection indicators with targeted therapy.
Related Concepts
- healthcare-associated-infections - MDROs are a major HAI driver with high complication burden.
- standard-precautions - Baseline behaviors reduce everyday transmission opportunities.
- transmission-based-precautions - Route-specific controls are central for resistant organism containment.
- hand-hygiene - Core intervention for reducing cross-transmission.
- sharps-disposal-and-needlestick-response - Occupational safety workflows support broader infection prevention.
Self-Check
- Which factors in this source increase MDRO risk in older adults?
- Why can persistent infection despite antibiotics suggest resistant-pathogen involvement?
- What immediate nursing actions reduce MDRO spread while culture-driven treatment is updated?