Administrative Office
St. Joseph's Hospital Site, L301-10
50 Charlton Avenue East
HAMILTON, Ontario, CANADA L8N 4A6
PHONE: (905) 521-6141
FAX: (905) 521-6142
http://www.fhs.mcmaster.ca/hrlmp/
Issue No. 77
QUARTERLY NEWSLETTER
October 2004
Antibiotic Resistant Organisms (ARO)
in the Community
Antibiotic Resistant Organisms (ARO) in the Community

What is an ARO and What Does It Do? See Table.

What precautions do I need to use when caring for a patient with an ARO?

Meticulous handwashing before and after any patient contact, and after handling equipment or
removing gloves.

If visiting hospitalized patients in precautions / isolation – follow the directions on the isolation
sign. Patients with Antibiotic Resistant Organisms will be in Contact Precautions. This means
that you will need to wear a gown and gloves whenever touching the patient or handling their
environment. Charts, stethoscopes and BP cuffs must not be taken in and out of Contact
isolation rooms without cleaning with hospital-approved germicide. Equipment is dedicated to
patient rooms as much as possible. Hospital disinfectant / cleaner is available to assist with
consistent disinfecting of shared equipment such as portable x-ray machines.

Patients should be provided education on the importance of handwashing and good personal
hygiene. If you are caring for patients in your office who are immunosuppressed, you may wish to
limit the time a patient affected by AROs spends in a waiting room. The risk of a patient
transmitting an ARO will depend on a number of factors, including body sites affected, general
level of health, and personal hygiene. You may wish to schedule a patient with an ARO at the
end of the day to reduce the risk of exposure to other patients.


What information do the patient and their family members receive while in hospital?
The patient and their families will often receive information about the ARO as well as instruction
in hand hygiene and how to decrease the risk of spreading the ARO. Infection Control
Practitioners are available to answer questions that patient’s or their families have about AROs,
that cannot be answered by their primary health care providers.
The Infection Control Practitioners at Hamilton Health Sciences (905-527-4322) are:
Lee Ramage – Manager – Ext. 42007
Anne Bialachowski – Hamilton General – Ext. 46141
Mary Catharine Orvidas – Hamilton General – Ext. 46189
Barbara Shea – Henderson Site – Ext. 42056
Kathryn Clark – MUMC – Ext. 75400
Virginia Tirilis – MUMC – Ext. 76310
The Infection Control Practitioners at St. Joseph’s Healthcare (905-522-1155) are:
Ruth Stevenson – Manager – Ext. 3347
May Griffiths-Turner Ext. 3385
Stephanie Trowbridge Ext. 3595
Barb Lang Ext. 6362
The Infection Control Practitioner at St. Peter’s Hospital is:
Suzanne Martin 905-777-3837 Ext. 12429
DETAILS
METHICILLIN RESISTANT
STAPHYLOCOCCUS AUREUS
(MRSA)
VANCOMYCIN RESISTANT
ENTEROCOCCUS (VRE)
MULTIRESISTANT
PSEUDOMONAS AERUGINOSA
(MRPA)
What is it?
Strain of Staphylococcus aureus
resistant to the most commonly used
antibiotics including Cloxacillin and
the Cephalosporins
Strain of Enterococcus resistant
to all antibiotics including
Vancomycin.
These are strains of Pseudomonas
that are resistant to many of the
antibiotics normally used to treat
them, including Ciprofloxacin.
These are plasmid-mediated enzymes
carried in gram-negative bacteria that
are capable of breaking down broadspectrum ß lactam antibiotics such as
cefotaxime, ceftriaxone, and
ceftazidime.
Where is it
found?
Colonizes skin but can spread to all
body sites, particularly invasive
devices such as indwelling urinary
catheters, IV and central lines,
Endotracheal tubes and decubiti,
post-operative wounds and blood.
Enterococcus is normal bowel
flora. VRE is readily detected
upon rectal swabs. VRE can
colonize a patient at other sites
including indwelling catheters,
decubiti, post-operative wounds
and invasive sites
Pseudomonas is a bacterium that is
found naturally in soil, water and
plants. It is often found in the throat
and feces of people and animals. It
is able to grow and survive in
standing water and some solutions.
Most common organisms with these
enzymes are
What types of
infections are
associated
with these
organisms?
MRSA usually colonizes a patient,
however, up to 50% of colonized
patients may develop infections.
MRSA has the ability to cause the
same type of infections as Staph.
aureus such as boils, post-operative
wound infections, cellulitis,
bacteremia, and toxic-shock
syndrome.
VRE usually colonizes a patient
but can cause infection
depending on patient’s
condition and site of infection.
Patients with Clostridium difficle
may be colonized with VRE.
Multi-resistant pseudomonas can be
a colonizer, but can also cause
respiratory tract infections, ear,
wound infections and urinary tract
infections.
ESBL’s can be colonizers but they have
also been implicated in infections. They
can cause infections at sites affected by
E. coli or Klebsiella species such as
urinary tract, bloodstream, and
respiratory tract.
What is the
treatment?
DECOLONIZATION THERAPY: Is
controversial and should be
individually assessed to determine if
they are a candidate, and if they can
tolerate therapy. Consultation with
Infectious Disease Physician may be
beneficial.
Colonization with VRE does not
require treatment.
Colonization with Multiresistant
pseudomonas does not require
treatment. If the patient has an
infection, consultation with an ID
physician is recommended.
Cephalosporins will not be effective but
are the most commonly used group of
antibiotics used to treat patients with
serious infections before the causative
organism is known. Consultation with
an Infectious Disease Physician may be
beneficial.
It is believed that Multiresistant
pseudomonas is spread in the same
manner as VRE and MRSA (on the
hands of personnel from infected or
colonized patients).
It is believed that ESBLs are spread in
the same manner as VRE and MRSA
(on the hands of personnel from
infected or colonized patients).
CLINICAL INFECTIONS: If the
patient is clinically infected,
Vancomycin is the drug of choice.
Vancomycin will NOT eradicate the
colonization state, therefore, should
only be used when a patient is
clinically infected.
How is it
spread?
BATHS: Antimicrobial soaps
containing Chlorhexidine or Triclosan
may be beneficial for 7-10 days.
These are available at most drug
stores.
Direct contact from touching a patient
colonized with MRSA and/or their
environment. Hands are the most
common source of transmission.
If a patient has a VRE infection,
they may benefit from a
combination of antibiotics, and
an Infectious Disease Physician
should be consulted.
Direct contact with the patient
and/or their environment.
Hands are the most common
source of transmission.
Lee Ramage, Mark Loeb, Cheryl Main and David Groves HRLMP
Discipline of Microbiology
Hamilton Regional Laboratory Medicine Program
EXTENDED- SPECTRUM BETALACTAMASE PRODUCING
ORGANISM (ESBL)
E. coli and Klebsiella species, which are
part of the normal intestinal flora.