Multidrug Resistant Organisms (MDRO) in Rehabilitation: Prevalence and Risk Factors for MRGN and VRE
Authors: Steul, Katrin; Schmehl, Cleo; Berres, Marlene; Hofmann, Sabine; Klaus-Altschuck, Andrea; Hogardt, Michael; Kempf, Volkhard A. J.; Pohl, Marcus; Heudorf, Ursel
BackgroundAfter a first large-scale study on multi-drug resistant organisms (MDRO) in rehabilitation facilities in 2014, the Rhine-Main network on MDRO carried out another investigation in 2019. With regard to the recently published KRINKO recommendations on multidrug resistant enterococci, now vancomycin -resistant enterococci (VRE) and multi-drug resistant gram-negative pathogens (3MRGN and 4MRGN, i. e. gramnegative organisms resistant against 3 resp. 4 groups of antiinfectiva) were investigated. Material and methodsA total of 16 hospitals took part, including one clinic for early neurological rehabilitation (ENR). Patient participation was voluntary. Rectal swabs were analyzed in a medical-microbiological laboratory (certified according to DIN ISO 15189) using standard methods (including MALDI-TOF-MS and VITEK 2 resistance testing according to EUCAST). By using the standardized questionnaire of the Europe-wide HALT examination (healthcare associated infections in long-term care facilities), patient characteristics (age, gender, hospital, surgical and MDRO medical history,Medical devices, current antibiotic therapy etc.) were collected. Results928 patients took part in the study, 895 from general rehabilitation facilities (GR) and 33 from early neurological rehabilitation (ENR). 65% of GR patients (ENR 100%) had been hospitalized in the previous 6 months, 29% (ENR 100%) of the patients had been admitted directly from a hospital, 22% (ENR 64%) had received antibiotic therapy in the last 3 months.Medical deviceswere rarely used in GR patients with 1% overall, but often in the ENR with 61% urinary catheters and 36% vascular catheters. 2.2% (ENR 33.3%) of GR patients were colonized with VRE and 6.7% (ENR 18.2%) with 3MRGN; one patient exhibited a 4MRGN (ENR 0). DiscussionCompared to our previous study, there were no significant changes in the patient characteristics. The VRE prevalence was low at 3.3%, the prevalence of 3MRGN was higher compared to 2014 (7.1% vs. 3.6%). Risk factors for VRE and 3MRGN colonization (significant increased odds ratio) were: history of hospital treatment and an increased need for care due to restricted mobility, incontinence and disorientation. In addition, previous antibiotic treatment and skin barrier injuries due toMedical devicesor wounds were detected as further risk factors for VRE colonization.
Overcoming Intrinsic and Acquired Resistance Mechanisms Associated with the Cell Wall of Gram-Negative Bacteria
Authors: Impey, Rachael E.; Hawkins, Daniel A.; Sutton, J. Mark; Soares da Costa, Tatiana P.
The global increase in multi-drug-resistant bacteria is severely impacting our ability to effectively treat common infections. For Gram-negative bacteria, their intrinsic and acquired resistance mechanisms are heightened by their unique cell wall structure. The cell wall, while being a target of some antibiotics, represents a barrier due to the inability of most antibacterial compounds to traverse and reach their intended target. This means that its composition and resulting mechanisms of resistance must be considered when developing new therapies. Here, we discuss potential antibiotic targets within the most well-characterised resistance mechanisms associated with the cell wall in Gram-negative bacteria, including the outer membrane structure, porins and efflux pumps. We also provide a timely update on the current progress of inhibitor development in these areas. Such compounds could represent new avenues for drug discovery as well as adjuvant therapy to help us overcome antibiotic resistance.