MDRO

(Multidrug-Resistant Organism)
How Important

HERI SUTANTO
DIVISI TROPIK INFEKSI ILMU PENYAKIT DALAM RS SAIFUL ANWAR – FK UNIBRAW
KPRA RSUD DR. SAIFUL ANWAR MALANG
 You know that
Pseudomonas
aeruginosa from Mr. T
in Bougenvil Room?
Is that an MDRO?
Why do you want to know?

 Your own internal monitoring

 “We’ve had a 35% increase in MRSA isolates this year.”
 For infection control purposes

precautions.”Who defines MDRO?
“All patients with MDR GNB are placed in contact

 Reporting to authorities
“We have to report all MDROs to the state.

You do,
Or whomever you’re producing
the data for
Why do you want to know?

 Your own internal monitoring

 “We’ve had a 35% increase in MRSA isolates this year.”
 For infection control purposes
 “All patients with MDR GNB are placed in contact
precautions.”
 Reporting to authorities
 “We have to report all MDROs to the state.
Who defines MDRO?

Your infection control team

Why do you want to know?


Who
Your own internal monitoring
defines MDRO?
 “We’ve had a 35% increase in MRSA isolates this year.”
 Hospital,
For infection control purposes State, Parent, Company
 “All patients with MDR GNB are placed in contact
precautions.”
 Reporting to authorities
 “We have to report all MDROs to the state.”
Hence, the problem…

Different people doing the

defining…

for different reasons…

…leads to different definitions.

I know one when I see one…

…well, maybe not.

 The Not Quite As Simple But Now The Closest
The Simplest
Thing We HaveApproach
to Universally Accepted
Approach

Resistant to > 1 drug

Non-susceptible>2 classes of
to drugs
XDR and PDR

Non-susceptible to at least 1
drug in all but two or fewer
classes

Non-susceptible to all
agents in all classes
What is a “class” of drugs?

Beta-lactams
What is a “class” of drugs?

Penicillins

Cephalosporins

Monobactams

Carbapenems
What is a “class” of drugs?

Aminopenicillins 1st gen. Cephalosporins

Ureidopenicillins 2nd gen.

Cephalosporins
Carboxypenicillins 3 gen. Cephalosporins
rd

ß-lactamase resistant 4th gen. Cephalosporins

penicillins
5th gen. Cephalosporins
ß-lactamase inhibitor
combinations Cefamycins

Monobactams Carbapenems
 What is resistance to a class?
Bug A Bug B Bug C Bug D
Gentami R R R I
cin
Tobramyc R R S S
in
Amikacin R S S S
Resistant
to this
class?
22 drugs in 17 classes

MDR – NS to at
least one drug in
at least 3 classes

XDR – NS to at
least one drug in
all but 2 or fewer
classes

PDR – NS to all
drugs in all
MDRO Definitions

Resistant to oxacillin, methicillin, or

cefoxitin, or positive by an FDA-
approved test for mecA on
isolated colonies or in specimens

Not a MRSA

http://www.cdc.gov/nhsn/PDFs/ps
cManual/12pscMDRO_CDADcurre
nt.pdf, January 2013
MDRO Definitions

Any Enterococcus resistant to

vancomycin or positive by an
FDA-approved test for VRE

Any Klebsiella non-susceptible to

ceftriaxone, cefotaxime,
ceftazidime, or cefepime***

***Based on new breakpoints

http://www.cdc.gov/nhsn/PDFs/ps
cManual/12pscMDRO_CDADcurre
nt.pdf, January 2013
MDRO Definitions

Non-susceptible to imipenem,
meropenem, or doripenem***, or
positive by a test for
carbapenemase

***Based on new breakpoints

http://www.cdc.gov/nhsn/PDFs/ps
cManual/12pscMDRO_CDADcurre
nt.pdf, January 2013
MDRO Definitions

http://www.cdc.gov/nhsn/PDFs/ps
cManual/12pscMDRO_CDADcurre
nt.pdf, January 2013
 Call this Based on new
one the breakpoints
“CRE
Back to CRE
Toolkit”

http://www.cdc.gov/hai/organisms/cre/cre-
 What We’ve Done

• Certain organisms are designated in microbiology

laboratory reports as MDROs.
• The Microbiology Laboratory makes this determination on
the basis of full susceptibility results from the MicroScan
and supplemental testing if necessary.
• The chief intent is infection control. All patients infected
with an isolate reported as an MDRO are put into contact
precautions.
Ideal Selektive Pressure Cross Talk
Faktor Antimikroba terhadap
Resistensi

 Penggunaan yang berlebihan

 Dosis yang terlalu rendah
 Interval dosis yang tidak sesuai
 Pemberian yang terlalu lama
 Penggunaan sebagai profilaksis
 Penggunaan pada bidang selain
kesehatan manusia
 Faktor resiko pasien yang
meningkatkan resistensi
 Penggunaan antibiotik yang berkepanjangan atau berulang
 Riwayat rawat inap di RS yang berulang atau dalam waktu
yang lama
 Pasien dengan penyakit kronis
 Pasien dengan usia lanjut atau terlalu muda (geriatri dan
neonatus)
 Pasien dengan immunokompromais
 Pasien dengan alat invasive (IV catheter, Cateter urine,
ventilator)
 Adanya alat yang menembus barier kulit (trakeostomi,
gastrostomi)
Pentingnya Mencegah
MDRO
 Transmisi MDRO
 Hand Higiene yang buruk
 Penggunaan sarung tangan dari pasien
satu ke yang lainnya
 Kontak dengan lingkungan yang
terkontaminasi
 Pembersihan alat yang inadekuat
(Tensimeter, Stetoskop)
 Hal-hal lain yang sering tidak diperhatikan
(jas dokter, dasi, jilbab, handphone)
www.rsusaifulanwar.jatimprov.go.id
Terima Kasih