Practical Management of Patients Infected with Resistant Organisms: An Infection Control Perspective

  • John M. Boyce
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 390)


Antibiotic resistant bacteria first became a major concern during the 1950’s with the emergence and widespread dissemination of penicillin-resistant strains of Staphylococcus aureus. However, in the 1970s and early 1980s, multi-drug resistant Gram-negative bacilli became the major problem confronting hospital-based infectious diseases clinicians and infection control programs.1,2,3 More recently, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci have emerged as major nosocomial pathogens.4,5,6 The emergence of multidrug resistant Gram-positive pathogens despite the use of accepted isolation procedures has prompted a reassessment of our approaches to infection control in the hospital setting. The purpose of this review is to discuss the epidemiology and prevention of resistant nosocomial pathogens, with emphasis on emerging Gram-positive pathogens.


Health Care Worker Resistant Organism Nasal Carriage Epidemic Strain Nosocomial Transmission 
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  1. 1.
    R.A. Weinstein, C. Nathan, R. Gruensfelder, and S.A. Kabins. Endemic aminoglycoside resistance in gram-negative bacilli: Epidemiology and mechanisms. J Infect Dis. 141: 338–345, 1981.CrossRefGoogle Scholar
  2. 2.
    D.R. Schaberg, C.E. Rubens, R.H. Alford, W.E. Farrar, W. Schaffner, and Z.A. McGee. Evolution of antimicrobial resistance and nosocomial infection. Am J Med. 70: 445–448, 1981.PubMedCrossRefGoogle Scholar
  3. 3.
    W.E. Stamm, R.A. Weinstein, and R.E. Dixon. Comparison of endemic and epidemic nosocomial infections. Am J Med. 70: 393–397, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    J.M. Boyce. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol. 11: 639–642, 1990PubMedCrossRefGoogle Scholar
  5. 5.
    A.L. Panlilio, Culver DH, Gaynes RP, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975–1991. Infect Control Hosp Epidemiol. 13: 582–586, 1992.PubMedCrossRefGoogle Scholar
  6. 6.
    T.R. Frieden, S.S. Munsiff, D.E. Low, et al. Emergence of vancomycin-resistant enterococci in New York City. Lancet. 342: 76–79, 1993.PubMedCrossRefGoogle Scholar
  7. 7.
    R.A. Weinstein and S.A. Kabins. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med. 70: 449–454, 1981PubMedGoogle Scholar
  8. 8.
    J.S. Garner, W.R. Jarvis, T.G. Emori, T.C. Horan, and J.M. Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 16: 128–140, 1988.PubMedCrossRefGoogle Scholar
  9. 9.
    P. Lynch, M.J. Cummings, P.L. Roberts, M.J. Herriott, B. Yates, and W.E. Stamm. Implementing and evaluating a system of generic infection precautions: body substance isolation. Am J Infect Control. 18: 1–12, 1990.PubMedCrossRefGoogle Scholar
  10. 10.
    J.M. Boyce, S.M. Opal, J.W. Chow, et al. An outbreak of multi-drug resistant Enterococcus faecium with transferable variB class vancomycin resistance. J Clin Microbiol. 32: 1148–1153, 1994.PubMedGoogle Scholar
  11. 11.
    National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial disk susceptibility tests. Approved standard M2–A4, M100–S3. National Committee for Clinical Laboratory Standards. Villanova, PA., 1991.Google Scholar
  12. 12.
    J.M. Swenson, B.C. Hill, and C. Thornsberry. Problems with the disk diffusion test for detection of vancomycin resistance in enterococci. J Clin Microbiol. 27: 2140–2142, 1989.PubMedGoogle Scholar
  13. 13.
    J.M. Swenson, M.J. Ferraro, D.F. Sahm, P. Charache, and National Committee for Clinical Laboratory Standards Working Group on Enterococci, Tenover FC. New vancomycin disk diffusion breakpoints for enterococci. J Clin Microbiol. 30: 2525–2528, 1992.Google Scholar
  14. 14.
    K.S. Meyer, C. Urban, J.A. Eagan, B.J. Berger, and J.J. Rahal. Nosocomial outbreak of Klebs iella infection resistant to late-generation cephalosporins. Ann Intern Med. 119: 353–358, 1993.PubMedCrossRefGoogle Scholar
  15. 15.
    R.N. Maslow, M.E. Mulligan, and R. D. Arbeit. Molecular epidemiology: application of contemporary techniques to the typing of microorganisms. Clin Infect Dis. 17: 153–164, 1993.PubMedCrossRefGoogle Scholar
  16. 16.
    K.H. Kim, R. Fekety, D.H. Batts, et al. Isolation of Clostridium domicile from the environment and contacts of patients with antibioitic-associated colitis. J Infect Dis. 143: 42–50, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    J.M. Boyce, G. Potter-Bynoe, C. Chevevert, and N.L. Hughes. Contamination of environmental surfaces with methicillin-resistant Staphylococcus aureus (MRSA): infection control implications. Presented at the Fourth Annual Meeting of the Society for Hospital Epidemiology of America, New Orleans, LA, March. (Abstract ), 1994.Google Scholar
  18. 18.
    J.M. Boyce, S.M. Opal, G. Potter-Bynoe, and A.A. Medeiros. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis. 17: 496–504, 1993.PubMedCrossRefGoogle Scholar
  19. 19.
    R.P. Wenzel, M.D. Nettleman, R.N. Jones, and M.A. Pfaller. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med. 91 (suppl 3B): 221S - 227S, 1991.PubMedCrossRefGoogle Scholar
  20. 20.
    M.E. Mulligan, K.A. Murray-Leisure, B.S. Ribner, et al. Methicillin-resistant Staphylococcus aureus: A consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med. 94: 313–328, 1993.PubMedCrossRefGoogle Scholar
  21. 21.
    J.M. Boyce, M.M. Jackson, G. Pugliese, el al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol. 15: 105–115, 1994.PubMedCrossRefGoogle Scholar
  22. 22.
    L.B. Rice, S.H. Willey, G.A. Papanicolaou, et al. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother. 34: 2193–2199, 1990.PubMedCrossRefGoogle Scholar
  23. 23.
    L. Naumovski, J.P. Quinn, D. Miyashiro, et al. Outbreak of ceftazidime resistance due to a novel extended-spectrum beta-lactamase in isolates from cancer patients. Antimicrob Agents Chemother. 36: 1991–1996, 1992.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • John M. Boyce
    • 1
  1. 1.Department of Medicine, Infectious DiseasesBrown University, the Miriam HopitalProvidenceUSA

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