The fight against infections also includes the fight against multi-resistant bacteria. We at AMIL Care know this well, and for this reason, we have decided to dedicate an in-depth article to the subject. 

Let’s start dealing with the topic of infections due to multi-resistant bacteria by understanding the first fundamental difference between them. In fact, depending on the time of onset, infections are divided into two categories: hospital (or nosocomial) infections and community infections. 

The first are those that arise during hospitalization, generally after about 48 hours from the moment of acceptance. The Covid-19 emergency has once again highlighted the critical issues posed by these infections in a healthcare system based on hospitalization.  

The latter are those already clinically manifest or incubating at the time of admission to the hospital. 

Furthermore, the category of community infections can be further divided into “community-acquired infections” and “healthcare-associated infections” (HAI). 

Usually, an infection is considered to be care-related if the patient who contracts it has been admitted to an intensive care unit for two or more days within 90 days of the onset of the illness or has resided in a nursing home; or has undergone intravenous antibiotic therapy, chemotherapy, or wound treatment within the last 30 days; or has recently attended a hospital or hemodialysis center.   

 What are multi-resistant bacteria?

Invisible, but highly lethal: multi-drug resistant organisms (MDROs) or antibiotic-resistant bacteria are one of the main enemies of human development. The WHO has listed them among the top 10 threats to global public health. 

But what are multiresistant bacteria? These are bacteria resistant to one or more classes of antibiotics available today. Typically, they are bacteria mostly associated with hospital infections and HAIs. However, some of them have become quite prevalent causes of community-acquired infections. This leads to significant growth in the population at risk. 

The spread of multi-resistant bacteria even outside hospital facilities is linked to the increase in morbidity, mortality, healthcare costs, and the use of antibiotics. Multi-resistant bacteria are generally not very virulent: their resistance to known antibiotic therapies makes them more dangerous than others. 

Multi-resistant bacteria: when they appear

Since anyone can be colonized by these bacteria, it is the host’s condition that will determine the onset of infection: as one can easily imagine, the most at-risk categories are, for example, immunosuppressed patients, patients suffering from multiple pathologies, patients undergoing frequent and invasive diagnostic therapies (such as bone marrow or solid organ transplants), and patients undergoing prolonged hospitalization. 

In addition to the severity of the clinical conditions, a risk factor for the onset of infection can also be the transfer of a hospitalized patient to another country or another facility. 

The main European organization responsible for the surveillance of infections caused by multi-resistant bacteria is the European Antimicrobial Resistance Surveillance Network (EARS-Net). The action of the network is based on protocols and data cyclically reported to the ECDC by the representatives of the Member States. The ECDC website features real patient stories that illustrate the challenges of treating infections of this type, and how they can affect daily life. 

In Italy, there is a diffusion among the highest in Europe for many multi-resistant bacteria. The cause is to be found in several elements, such as high or inappropriate consumption of antibiotics, poor hand hygiene, insufficiently coordinated control, and monitoring actions. 

What are antibiotic-resistant bacteria, and how do they work?

We started talking about the characteristics of antibiotic-resistant bacteria. It is therefore natural to ask which are, in fact, the most common of these bacteria. Currently, the most common multiresistant bacteria are: 

  • Staphylococcus aureus with reduced sensitivity to glycopeptides (VISA); 
  • Methicillin-resistant Staphylococcus aureus (MRSA): this is the most common in the community, as well as the one that has the greatest impact on morbidity and mortality; 
  • Vancomycin/teicoplanin-resistant enterococci (VRE); 
  • Gram-negative non-fermenting bacilli (Pseudomonas spp., Acinetobacter spp., etc.) 
  • Enterobacteria – producers of ESBLs (extended spectrum beta-lactamases). 

According to the data collected in the AR-ISS 2021 report, the percentage of resistance to third-generation cephalosporins in Escherichia coli is decreasing in 2021 (23.8%) compared to 2020 (26.4%), while a trend in the decline in the years 2015-2021 is observed for aminoglycosides (from 18.4% in 2015 to 13.9% in 2021) and fluoroquinolones (from 44.4% in 2015 to 32.5% in 2021). 

Multi-resistance to antibiotics, among other things, has different characteristics depending on different factors. In general, we can say that the bacterium can manifest its multi-resistance mainly in two ways. It may have several resistance genes, each of which opposes a particular antibiotic. The accumulation of resistance genes often occurs on small fragments of DNA called plasmids, which can be transferred between bacteria in a single event. Or, a single resistance mechanism can act against more than one antibiotic. For example, one resistance strategy used by these bacteria is to pump the antibiotic out of the cell. Sometimes such efflux pumps can recognize many molecules, including different types of antibiotics. This means that bacteria can use a single efflux pump to fend off different antibiotics. This activity is also called “cross resistance”. 

As regards the parts of the body affected by multiresistant bacteria, the most frequently colonized sites are the urinary tract, the skin or underlying tissue for pressure sores, the gastrointestinal tract, and the respiratory tract. 

Environmental sanitation from multi-resistant bacteria 

The problem of the growth of multi-resistant bacteria presents itself as a somewhat vicious circle: antibiotics are being used on an ever-increasing scale throughout the world, and the more they spread, the more resistant microbes develop. 

With this knowledge in mind, it is essential that public and private entities are aware of and take the most appropriate measures to prevent the emergence of these bacteria and, above all, the infections resulting from them. 

In health and social care facilities, the management of patients with microbiological positivity to one or more multi-resistant bacteria necessarily requires the constant application of specific care practices, aimed at reducing their circulation and transmission as much as possible. 

An important role in countering them is played by prevention, in the form of correct sanitization of environments. Creating and preserving an environment with a low microbial load is, in fact, the first step in counteracting the formation of multi-resistant bacteria. 

However, it is necessary to pay attention to the substances used because even the effectiveness of disinfectants for environments could be compromised by bacterial mechanisms. While the comparison of bactericidal values ​​obtained from the research so far is still being studied, carrying out practical tests on surfaces is ideal for determining the actual bacterial sensitivity to different disinfectants. 

AMIL Care, a valid ally against multi-resistant bacteria

Ultimately, the most effective way to combat multi-resistant bacteria is to activate a synergistic set of activities that include disease prevention, awareness campaigns, provision of better sanitation services, screening of infected patients, and constant surveillance. 

And, as far as environmental sanitation is concerned, always rely on professionals in the sector able to guarantee the safety and efficacy of the results. 

To find out how to sanitize an environment, AMIL Care makes its expertise available in the hospital field and beyond, to support the fight against multi-resistant bacteria. As always, we invite you to contact us for any doubts, questions, or curiosities about sanitizing environments.