Multi-Drug Resistant Organisms (MDROs) Playing the Pandemic to Their Advantage? Part 1
The Battle at Hand:
There is concern that COVID-19 hospitalizations will affect current efforts to mitigate transmission of multi-drug resistant organisms (MDROs) and impact antimicrobial resistance (AMR). A recent article discussed how the infection prevention and treatment practices of the COVID-19 pandemic response may impact MDRO containment efforts1. Some of these practices may be protective, such as increased hand hygiene in the hospital, community social distancing practices, cancelation of routine procedures and increased use of telemedicine, as they would theoretically reduce the risk of MDRO exposure (less inpatients with MDRO carriage). Additionally, transmission risk and antimicrobial prescribing practices may decrease due to less patients seeking medical care both in the healthcare and community setting1.
However, there are many other healthcare responses to the pandemic which may increase the incidence of MDROs and potential for AMR spread1:
- MDRO isolation rooms allocated to COVID-19 patients, paired with prioritized personal protective equipment (PPE) for COVID-19 admissions
- Increased use of empiric antimicrobial prescribing for patients with respiratory symptoms
- Increased use of telemedicine may increase “safety net” antimicrobial prescribing in the community
- Antimicrobial stewardship teams being utilized differently to handle the strain to healthcare due to pandemic which may lead to a periodic reduced focus on AMR efforts
- Healthcare facilities becoming overwhelmed with COVID-19 admissions may lead to overcrowding and increased transmission of MDROs
- Decreased MDRO screening due to laboratory diagnostics and staff focus on COVID-19.2
An MDRO of particular concern both before and during this pandemic is not of the bacterial variety
Candida auris (C. auris) is an emerging and difficult to identify and treat fungus. Due to laboratory identification constraints and frequently limited treatment options, this MDRO often is inappropriately clinically managed,3 exacerbating transmission and tracking efforts. C. auris can persist for weeks to months on surfaces and common disinfectants are less effective at eliminating it in the environment. [The CDC recommends either a product with an EPA registered C. auris kill claim OR product approved on EPA’s List K.] As with many MDROs, individuals can be colonized without infection contributing to the ease of further spread, causing healthcare outbreaks3.
Read Part 2 of to learn more about the potential threat of C. auris during this coronavirus crisis.
- Rawson, Timothy M., et al. “COVID-19 and the potential long-term impact on antimicrobial resistance.” Journal of Antimicrobial Chemotherapy(2020).
- Martin, Ellen, et al. “Antimicrobial stewardship challenges and innovative initiatives in the acute hospital setting during the COVID-19 pandemic.” Journal of Antimicrobial Chemotherapy(2020).
- Centers for Disease Control and Prevention. Candida auris. https://www.cdc.gov/fungal/candida-auris/. Accessed 11/18/2020.