What is a multidrug resistant organism (MDRO)?

Multidrug-resistant organisms, or MDROs, are bacteria that are resistant to at least three families of antibiotics. This means the antibiotics don’t work to treat your infection. While rare, some MDROs are resistant to all types of antibiotics.

Examples of multidrug-resistant organisms include:

• Carbapenem-resistant Acinetobacter baumannii
• Third-generation cephalosporin-resistant Enterobacterales
• Carbapenem-resistant Enterobacterales
• Rifampicin-resistant Mycobacterium tuberculosis
• Fluoroquinolone-resistant Salmonella Typhi
• Fluoroquinolone-resistant Shigella spp.
• Vancomycin-resistant Enterococcus faecium
• Carbapenem-resistant Pseudomonas aeruginosa
• Fluoroquinolone-resistant non-typhoidal Salmonella
• Third-generation cephalosporin, and/or fluoroquinolone-resistant Neisseria gonorrhoeae
• Methicillin-resistant Staphylococcus aureus (MRSA)

The type of MDRO a patient has will determine what type of infection they have. For example, E.coli can cause urinary tract infections, intra-abdominal infections and pneumonia.

MDROs are a huge public health concern worldwide. When antibiotics can’t be used, people with infections are at a higher risk of poor outcomes and death.

Are MDRO infections contagious?

Yes, most MDRO infections are contagious.

They can pass between people by skin contact or through bodily fluids. For example, MDRO infections can spread from one patient to another or from a staff member to a patient.

MDRO infections can also spread without physical contact. You can get an MDRO infection from your environment, such as an unclean hospital room. For example, a patient may be exposed to infection by touching a remote or surface that wasn't properly sanitized.

How are MDRO infections treated?

MDROs don’t respond to first-line, or preferred, antibiotics. First-line antibiotics are the ones best suited to treating a specific infection. Instead, MDRO infections must be treated with another antibiotic or a combination of antibiotics.

To treat MDRO infections, you may have to take antibiotics that are more toxic or cause more side effects than the first-line option. These options may affect the liver and kidneys.

Unfortunately, there aren’t a lot of options for treating MDROs. That’s why MD Anderson takes infection control seriously. By preventing the spread of MDRO infections, we are protecting our patients and community.

How does MD Anderson prevent MDRO infections?

An MDRO infection can complicate or even delay cancer treatment. This might mean a patient has to wait to get a transplant or receive chemotherapy.

That's why, at MD Anderson, we do whatever it takes to limit the spread of MDROs. We take a two-pronged approach to preventing MDRO infections. Our Antimicrobial Stewardship Program works to prevent MDRO infections, while our Infection Control team works to stop them from spreading.

MDRO infections can be triggered by overusing antibiotics, taking them for too long or using them inappropriately. That's why our Antimicrobial Stewardship Program works to ensure that each patient who needs antibiotics is prescribed the right ones and uses them for the correct amount of time.

We take pride in limiting the number of patients with MDRO infections. MD Anderson patients who are in the Intensive Care Unit or who have blood cancers are tested for a type of MDRO called Vancomycin-Resistant Enterococci, or VRE, each week. Patients with MDRO infections are isolated to prevent spreading infection to other patients, and their providers wear protective equipment, including gowns and gloves.

We also take extra precautions when cleaning patients' rooms. In addition to regular housekeeping, we use ultraviolet light to disinfect rooms after one patient leaves and another checks in.

How can we prevent MDRO infections?

The simplest way you can prevent MDRO infections is proper hand hygiene. This means washing your hands with soap and water or using an alcohol-based sanitizer. To ensure your hands get clean, lather up with soap and water and scrub all parts of your hands — back, front, between your fingers, around your cuticles and under your nails — for at least 20 seconds before rinsing off the suds. 20 seconds is about how long it takes you to either sing the ABC song once or “Happy Birthday to You” twice.

Another simple way to prevent MDRO infection? Don’t overuse antibiotics. Sometimes, people may think that antibiotics cure everything, but that isn’t the case. Antibiotics treat infections caused by bacteria, not viruses. When you use antibiotics that you don't need, the body may create resistance to bacteria. As a result, your body might not respond to antibiotics when you do need them. That’s why you shouldn’t ask your doctor to prescribe antibiotics unless they are needed. And if you’re not sure why your doctor is prescribing antibiotics, ask why they recommend them.

Roy Chemaly, M.D., is chair of Infectious Diseases, Infection Control & Employee Health at MD Anderson.

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