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

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.