Multi-Drug Resistant Organisms (MDRO)

What is a Multi-Drug Resistant Organism?

Multi-drug resistant organisms (MDROs) are bacteria that have become resistant to several commonly used antibiotics. These bacteria are present in the gut or on the skin usually causing no harm – this is known as “colonisation”. MDROs can also be found in the environment, including water systems. 

E-coli, Klebsiella, Enterobacter, Pseudomonas and Acinetobacter are examples of bacteria that can be multi-drug resistant. Infections caused by MDROs can be more difficult to treat, as the choice of antibiotics to treat the infection can be limited. 

You may not need antibiotic treatment if you do not have an active infection but are colonised with a multi-drug resistant organism. Colonisation means that the bacteria are present, in the gut or on the skin for example, but are not causing infection. 

What infections can MDROs cause?

Multi-drug-resistant bacteria cause similar infections to other bacteria including urinary tract, pneumonia, wound and infections in the blood. 

How do I get an MDRO?

It is often hard to know exactly where or how someone picked up a bacteria. People receiving lots of different antibiotics are more likely to develop resistant strains of bacteria such as MDROs.

MDROs can be spread through person-to-person contact, through sharing items with a person that has the bacteria or through contact with a contaminated surface or equipment.

Who is at risk of infections caused by MDROs?

Certain risk factors are associated with carrying MDROs including: 

• Medical devices such as urinary catheters and cannulas. 
• Wounds and surgical incisions.
• Frequent and repeated use of antibiotics (which can allow resistant bacteria to grow).
• Frequent/prolonged hospital stays.
• Admission to an intensive care unit. 
• Weakened immune system.

What happens if I am colonised with an MDRO or have an infection?

When in hospital you may be cared for in a single room with an ensuite toilet. Hospital staff will wear aprons and gloves to care for you and perform appropriate hand hygiene.

It might not always be possible to be cared for in a room on your own and depending on a risk assessment you may be nursed in a bay with similar precautions.

These bacteria may stay in the body for months, but antibiotics are not required unless you get an infection.

How can I prevent the spread of MDROs?

Both colonised and infected people can spread the bacteria. They spread particularly easily if patients have diarrhoea. MDROs can enter the body through open wounds and devices.  

Hand washing is important to stop the spread of MDROs.

• Regularly wash your hands with soap and water, especially after going to the toilet and before eating (staff will assist you if you need help).
• Use alcohol sanitiser (alcohol gel) available on the ward when your hands are visibly clean.  Soap and water hand wipes can also be used.
• Avoid touching medical devices if you have them, such as urinary catheters, intravenous cannulas, and wounds.
• Let the nursing staff know if you develop diarrhoea.
• Your room or bed area will be cleaned once a day – please help the domestics by keeping your room tidy and placing your belongings in the bedside cabinet provided.

All hospital staff should perform hand hygiene when they enter and leave your room or approach your bedside.

Will I have to stay in hospital longer?

Unless you develop an infection, you will not necessarily need to stay in hospital longer. However, if you do develop an infection, some of the antibiotics used to treat MDROs are given via injection, so you might need to stay in hospital whilst the infection is being treated.

How are MDROs treated?

• Not all patients with MDROs need treatment. Sometimes the bacteria live in the gut, urine or wound, for example, without causing infection.
• Your doctor or GP will prescribe antibiotics solely for an infection, as careful use of antibiotics is essential in reducing the risk of bacteria developing resistance.
• If antibiotics are needed while you are an inpatient, they will be prescribed using the hospital’s antibiotic guidelines and they will be monitored closely.

Is there any risk to my family/visitors?

MDROs are not usually a risk for healthy people. Visitors should wash their hands or use alcohol-based hand rub (hand gel) before entering the patient’s room and again when leaving.

If visitors are helping with your personal care, the nursing staff may advise extra precautions, such as gloves and aprons.

What advice should I follow at home?

Good hand hygiene is important after you leave hospital. There is no need to take special precautions at home. Normal household cleaning practices, including your laundry should be in place.  

Please tell healthcare workers that you are colonised with a MDRO if: 

• You are seeing new doctors.
• Attending a different hospital.
• You return to hospital.
• Please also tell your GP.

This is important to ensure you get the most effective antibiotics if you were subsequently treated for an infection. 

If you are discharged on antibiotics to treat an infection it is important that you complete the course prescribed. 

The MDRO result will be on the discharge summary from UCLH, to inform your GP. 

Where can I get more information?

• Talk to the medical or nursing staff caring for you. 
• You can ask to talk to the Infection Prevention and Control Team.  
• UK Health Security Agency (UK-HSA). 
• Health matters: preventing infections and reducing antimicrobial resistance - GOV.UK

Contact details

• Infection Prevention and Control Team
  Direct line: 0203 447 9716  
• Website: www.uclh.nhs.uk