MDRO Infections Chapter 21

36 Questions

What percentage of deaths are associated with multidrug-resistant organisms in hospitalized patients?

1/17

What is the primary mode of transmission for Methicillin-Resistant Staphylococcus Aureus?

Contact

What is the primary factor contributing to the increased incidence of Methicillin-Resistant Staphylococcus Aureus infections?

Poor antibiotic stewardship

What is the most common clinical manifestation of Methicillin-Resistant Staphylococcus Aureus infection?

Skin and soft tissue infection

What percentage of patients acquire Methicillin-Resistant Staphylococcus Aureus infections within 48 hours of hospitalization?

68%

What is the estimated number of severe infections caused by Methicillin-Resistant Staphylococcus Aureus per year?

70,000

What is the primary purpose of administering antibiotics in the management of multidrug-resistant organisms?

To treat the underlying infection

What is the primary goal of contact-isolation precautions in the management of multidrug-resistant organisms?

To reduce the risk of transmission to others

What is the purpose of stopping the administration of the causative antimicrobial agent in the management of multidrug-resistant organisms?

To reduce the risk of antibiotic resistance

What is the primary benefit of encouraging early mobilization in the management of multidrug-resistant organisms?

To improve clinical outcomes and reduce the risk of complications

What is the purpose of administering supplemental oxygen in the management of multidrug-resistant organisms?

To improve oxygenation and reduce the risk of respiratory complications

What is the primary benefit of performing wound care in the management of multidrug-resistant organisms?

To prevent the development of wound infections

What is a potential side effect of using vancomycin to treat MRSA infections?

Nephrotoxicity and ototoxicity

What is the first step in managing a patient with a C-Diff infection?

Stop the causative antibiotic

A patient is diagnosed with a VRE infection. What is the next step in management?

Perform susceptibility testing to guide treatment

A nurse is assessing a patient with a suspected MRSA infection. What would the nurse expect to find?

Fever and tachycardia

A patient with an MDR infection is at risk for which of the following?

All of the above

What is a key aspect of nursing management for a patient with an MDR infection?

Monitoring vital signs and oxygen saturation

What is a potential complication of Vancomycin-Resistant Enterococci infection?

Endocarditis

How long can Vancomycin-Resistant Enterococci remain viable on environmental surfaces?

Up to 2 months

What is a risk factor for Vancomycin-Resistant Enterococci infection?

Prolonged hospital stay

How is Vancomycin-Resistant Enterococci typically transmitted?

Direct contact from skin or patient care equipment

What is a clinical manifestation of Vancomycin-Resistant Enterococci infection?

Urinary tract infections

What is a pathophysiological mechanism of Vancomycin-Resistant Enterococci?

Antibiotic resistance

What clinical manifestation would indicate the need for immediate intervention by the nurse?

Oliguria

What is the underlying pathophysiology correlated with the clinical manifestation of hyperglycemia?

Inadequate insulin production

Which of the following is a clinical manifestation of the patient's underlying condition?

Red, edematous, draining wound

What is the correlation between the patient's symptoms and the underlying pathophysiology?

The patient's symptoms are a result of inadequate insulin production.

What is the primary clinical manifestation that indicates the need for further teaching?

Stopping antibiotics when feeling better

What is the correlation between the patient's clinical manifestations and the need for transitional care plans?

The patient's symptoms indicate the need for follow-up with a home-care nurse.

What is the primary way Methicillin-Resistant Staphylococcus Aureus is transmitted?

Through skin-to-skin contact

What is the most common multidrug-resistant pathogen?

Methicillin-Resistant Staphylococcus Aureus

Which of the following is a risk factor for developing Methicillin-Resistant Staphylococcus Aureus infection?

Residing in a long-term care facility

What is a common clinical manifestation of Methicillin-Resistant Staphylococcus Aureus infection?

Pneumonia

What percentage of Staphylococcus aureus cultures are Methicillin-Resistant?

80%

How many deaths are associated with multidrug-resistant organisms in hospitalized patients?

98,000

Study Notes

MDRO Epidemiology

1.7 million hospitalized patients per year are affected by multidrug-resistant organisms (MDROs)
98,000 deaths occur annually due to MDROs (1/17 patients)
MDRO cases increased with the COVID-19 pandemic:
- 65% increase in central line-associated bloodstream infections (CLABSI) in ICUs
- 35% increase in ventilator-associated events (VAE)
- 43% increase in catheter-associated urinary tract infections (CAUTI)

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Epidemiology:
- 80% of staph aureus cultures are MRSA
- Most common multidrug-resistant pathogen
- 70,000 severe infections occur annually with 9,000 deaths
- 68% of cases are acquired within 48 hours of hospitalization due to poor antibiotic stewardship
Risk factors:
- Hospitalization in the last 12 months
- Soft tissue infection
- Hospitalization in intensive care
- Residing in a long-term care facility
- Immunosuppression
Pathophysiology: Contact with the pathogen
Clinical manifestations:
- Pneumonia
- Skin and soft tissue infection
- Bloodstream infection
Complications:
- Increased morbidity and mortality
- Osteomyelitis
- Toxic shock syndrome
- Multisystem organ failure

Vancomycin-Resistant Enterococci (VRE)

Epidemiology:
- Lower incidence in western US than eastern US
- Higher incidence in larger teaching hospitals
- Lower incidence with hand-hygiene compliance
- Increased with poor antibiotic stewardship
Risk factors:
- Prolonged hospital stays
- Immunosuppressed
- Prolonged exposure to antibiotics
- Invasive procedures and devices
Pathophysiology: Direct contact from skin or patient care equipment
Clinical manifestations:
- Urinary tract infections
- Peritonitis
- Bacteremia
- Wound infection
Complications:
- Vancomycin-resistant S. aureus
- Prolonged hospital stay
- Prolonged antibiotic therapy
- Higher mortality
- Increased cost of hospitalization
- Endocarditis

Management of Multidrug-Resistant Organisms

Medical management:
- MSRA: Vancomycin with trough levels; Linezolid (bacteriostatic) as an alternative
- VRE: Difficulty in treating due to resistance to penicillin and ampicillin; requires susceptibility testing
- C-Diff: Stop causative antibiotic, oral vancomycin, probiotics, and fecal microbiota transplantation
Nursing management:
- Assessment and analysis:
  - Look for typical signs of infection (fever, tachycardia, tachypnea, hypovolemia, diarrhea, wound infections)
- Nursing diagnoses:
  - Risk for deficient fluid volume
  - Ineffective airway clearance
  - Alteration in comfort
  - Risk for perineal skin breakdown
  - Impaired tissue integrity
  - Impaired urinary elimination
  - Acute pain
- Nursing interventions:
  - Hand hygiene
  - Isolation precautions
  - Antibiotic administration
  - Fever reduction
  - Pain management
  - IV fluid administration
  - Oxygen therapy
  - Chest physiotherapy
  - Early mobilization
  - Wound care
  - Perineal care
  - Fecal diversion systems
- Teaching:
  - Contact-isolation precautions
  - Medication regimen
  - Clinical manifestations of infection
  - Sun protection

Test your knowledge on multidrug-resistant organism infections, including epidemiology, prevention, and management. Learn about the impact of COVID-19 on MDROs and how to coordinate care for patients with these infections.

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