Home › Forums › Infexion Connexion › Screening on admission for MRGNs › Re: Screening on admission for MRGNs
Author:
Thomson, Rachel EA
Email:
Rachel.Thomson@DHHS.TAS.GOV.AU
Organisation:
State:
Hi Michael,
The Royal Hobart Hospital has recently implemented a protocol in
relation to MRGNs after pretty extensive work and consultation by our ID
and Micro team. We have updated our screening protocol in-line with
this. Simply put this is what we do
Screening in relation to MRGNs;
* Patients directly transferred from an overseas hospital
* Patients who have been admitted overnight to an overseas
hospital within the past 12 months
* Patients directly transferred from an intra-state or
inter-state intensive care unit
We only recommend isolation for those patients who are direct transfers
We classify our MRGNs as follows (and therefore look for the following);
* Acinetobacter spp. isolates intermediate/resistant to any
carbapenem
* Pseudomonas aeruginosa isolates resistant to at least 3 of the
following:
o Anti-pseudomonal carbapenem (meropenem, imipenem or doripenem)
o Gentamicin AND tobramycin
o Piperacillin/tazobactam AND ticarcillin/clavulanic acid
o Ciprofloxacin
o Ceftazidime AND cefepime/cefpirome
* Enterobacteriaceae isolates (excluding Salmonella and Shigella
spp.):
o intermediate/resistant to any Carbapenem
OR
o resistant to ampicillin/amoxycillin AND first generation
cephalosporins AND at least 3 of the following:
* Gentamicin AND tobramycin
* Ciprofloxacin OR norfloxacin
* Ceftriaxone OR ceftazidime
* Amoxycillin-clavulanate AND either ticarcillin-clavulanate or
piperacillin-tazobactam
* Any Gram-negative organism identified to have a transmissible
resistance mechanism such as:
o extended spectrum beta-lactamase (ESBL)
OR
o carbapenemase (including metallo-beta-lactamases (MBL) and
Klebsiella pneumoniae carbapenemases (KPC))
* Any other Gram-negative organism at the discretion of the
Medical Director of the Infection Prevention and Control Unit (or
delegate) – Hedging our bets here 🙂
Hope this is of assistance and interest. I would love to know what
other centres are doing!!
Cheers
Rachel
Rachel Thomson
Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au
________________________________
Behalf Of Michael Wishart
Hi all
Have a question about who is screening for what in regard to
multiresistant gram negatives on admission. I mainly want to know about
routine screening on admission to an acute facility on transfer from
another facility, not specifically what you screen for in high risk
units like ICU or dialysis, but all information is welcome!
Specifically, does anyone look for plasmid-mediated Amp-C betalactamase
producers in routine rectal screens?
Thanks
Michael (and yes, I have moved jobs yet again!)
Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
w:www.holyspiritnorthside.org.au
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