Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party

Research output: Contribution to journalArticle


  • A P R Wilson
  • D M Livermore
  • J A Otter
  • R E Warren
  • P Jenks
  • D A Enoch
  • W Newsholme
  • B Oppenheim
  • A Leanord
  • C McNulty
  • G Tanner
  • S Bennett
  • M Cann
  • J Bostock
  • E Collins
  • S Peckitt
  • L Ritchie
  • C Fry

Colleges, School and Institutes

External organisations

  • Consultant Microbiologist, Department of Microbiology and Virology, University College London Hospitals, London, UK. Electronic address:
  • University of East Anglia
  • Epidemiologist, Infection Prevention and Control, Imperial College Healthcare NHS Trust, London, UK.
  • Retired Consultant Microbiologist, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK.
  • Consultant Microbiologist, Plymouth Hospitals NHS Trust, Plymouth, UK.
  • Consultant Microbiologist, Public Health England, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
  • Consultant in Infectious Diseases, Infection Control and General Medicine, Department of Infection, St Thomas' Hospital, London, UK.
  • Consultant Microbiologist, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK.
  • Consultant Microbiologist, Southern General Hospital, Glasgow, UK.
  • Head of Primary Care Unit, Public Health England, and Honorary Visiting Professor Cardiff University, Microbiology Department, Gloucester Royal Hospital, Gloucester, UK.
  • Colorectal Cancer Patient Representative, North Bristol NHS Trust, Bristol, UK.
  • Patient Representative, Member of Health Care Acquired Infections, Service Users Research Forum, Leicester, UK.
  • Trustee, MRSA Action, Kirkham, UK.
  • Patient Representative, Member of Health Care Acquired Infections, Service Users Research Forum, London, UK.
  • Clinical Lead Infection Prevention, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.
  • Infection Prevention and Control Lead for North Yorkshire and Humber Commissioning Support Unit, Hull, UK.
  • Nurse Consultant Infection Control, Infection Control Team/HAI Group, Health Protection Scotland, Glasgow, UK.
  • Nursing Officer - Communicable Diseases Infectious Diseases and Blood Policy, Department of Health, London, UK.


1. Executive summary
Multi-drug-resistant (MDR) Gram-negative bacterial infections have become prevalent in some European countries. Moreover, increased use of broad-spectrum antimicrobial agents selects organisms with resistance and, by increasing their numbers, increases their chance of spread. This report describes measures that are clinically effective for preventing transmission when used by healthcare workers in acute and primary healthcare premises. Methods for systematic review 1946–2014 were in accordance with SIGN 501 and the Cochrane Collaboration;2 critical appraisal was applied using AGREEII.3 Accepted guidelines were used as part of the evidence base and to support expert consensus. Questions for review were derived from the Working Party Group, which included patient representatives in accordance with the Patient Intervention Comparison Outcome (PICO) process. Recommendations are made in the following areas: screening, diagnosis and infection control precautions including hand hygiene, single-room accommodation, and environmental screening and cleaning. Recommendations for specific organisms are given where there are species differences. Antibiotic stewardship is covered in a separate publication.

2. Lay summary
MDR Gram-negative bacteria are bacteria (or germs) that are resistant to at least three different antibiotics. These bacteria are commonly found in the gut, where they do no harm; however, they can cause infection at other body sites, mainly in patients who are vulnerable due to other underlying diseases, injury or hospitalization. Infection often happens when the bacteria enter the body through an open wound or via a medical device such as a catheter. Infections caused by MDR Gram-negative bacteria are difficult to treat, and can cause additional pain to patients with slow wound healing and other complications such as pneumonia or infection in the blood. This can prolong the length of stay in hospital and, in some cases, can cause death.

Some types of resistant Gram-negative bacteria can be carried on the skin rather than the gut, again with no obvious signs or symptoms. ‘Colonization’ describes this carriage of bacteria in the gut, on the skin or in the nose, throat or elsewhere on the body. Although the patients lack symptoms of infection, they may still need to be isolated/segregated and/or other contact precautions may be necessary in order to stop their resistant bacteria spreading to others.


Original languageEnglish
Pages (from-to)S1-44
JournalThe Journal of hospital infection
Issue numberSuppl 1
Publication statusPublished - 4 Jan 2016


  • Disease Transmission, Infectious, Drug Resistance, Multiple, Bacterial, Gram-Negative Bacteria, Gram-Negative Bacterial Infections, Health Plan Implementation, Health Planning Guidelines, Humans, Infection Control, Journal Article, Practice Guideline