Multidrug Resistance: A Growing Threat of Carbapenem-Resistant Gram-Negative Organisms in Health Care

Nurses are well aware of the problems with multidrug-resistant organisms (MDROs) and their ubiquitous presence across health care settings. Care issues and outcomes among patients with MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and Clostridioides difficile (C. diff) have increased awareness, but MDROs remain a growing challenge in the provision of care in virtually all health care settings.

Carbapenem-resistant Gram-negative bacteria, another example of MDROs, have emerged as one of the most urgent public health challenges globally. Organisms such as carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high morbidity, mortality, prolonged hospitalization, and limited treatment options. According to the World Health Organization (WHO), carbapenem-resistant A. baumannii and carbapenem-resistant Enterobacterales are among the highest-priority pathogens due to their rapid spread and severe clinical consequences (WHO, 2024).

Mechanisms of Carbapenem Resistance

Carbapenem resistance develops when bacteria change in ways that allow them to survive despite antibiotic treatment. Nurses and other health care personnel benefit from understanding these mechanisms because they directly relate to infection prevention activities, equipment cleaning and disinfection, and antimicrobial stewardship efforts.

Examples of how resistance develops are outlined below:

  1. Bacteria Produce Enzymes That Break Down the Antibiotic (Carbapenemase production)

Some bacteria create special enzymes that destroy carbapenem antibiotics before they can work. These are called carbapenemases. Common types of these enzymes include KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi metallo-beta-lactamase), VIM (Verona integron-encoded metallo-beta-lactmase), IMP (Imipenemase metallo-beta-lactamases), and OXA-48 (Oxacillinase-48).  These enzyme abbreviations/names may be familiar, as they have been seen […]

2026-01-05T11:14:29-05:00January 5th, 2026|infectious diseases, Nursing, Public health|0 Comments
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Just One Braid: The Power of Small Gestures to Restore Patient Dignity

Have you ever found yourself walking around your unit, overwhelmed by the prospect of managing your ever-growing workload? It sometimes feels like a never-ending cycle of assessments, medications, admissions, and discharges. I believe I’m not the only nurse who has experienced this frustration.

It is difficult to admit that, when COVID-19 entered our hospital doors, these thoughts consumed me. We witnessed the first casualties—not just of lives, but also of hope and intimacy—as we struggled to provide care and overcome our own anxieties amidst a scarcity of personal protective equipment (PPE).

Over time, we all learned a great deal about adapting to and managing a pandemic, and I have become more aware of my role within our flawed health care system. Focusing on my own fears and needs was valuable, of course, but these years opened my eyes to the injustices patients face. A significant proportion of the lives lost from COVID-19 due to ill-prepared infrastructure were from vulnerable communities. These realities transformed my perception of these injustices from distant awareness to concrete urgency.

Braiding a patient’s hair, restoring a sense of self.

The question of injustice brings to mind a recent encounter with a patient that deeply impacted me. This particular patient was young and […]

2023-05-25T12:20:32-04:00May 25th, 2023|Nursing, nursing stories, patient experience|1 Comment
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Respiratory Illness Surge: Differentiating and Treating RSV, COVID, and Flu in Children

Concern about a respiratory ‘triple-demic.’

Electron micrograph image of respiratory syncytial virus (RSV)/Image source: CDC

Take a walk through many of the country’s pediatric emergency departments (EDs) and inpatient units right now and you will be greeted with the sounds of pinging monitors, suction, and coughing as “respiratory season” settles in.

This will be the first fall and winter that many young children have been back at schools and day cares, largely unmasked, in nearly three years. While respiratory syncytial virus (RSV) and influenza are yearly problems in pediatrics, an unseasonably early and severe surge in RSV is causing an unprecedented number of hospital admissions that is already straining many health systems.

Public health officials are already warning of a “triple-demic” this year as the current RSV surge coalesces with expected rises in influenza and COVID cases. This, of course, does not include the dozens of other respiratory viruses that affect children each winter, including the atypically severe cases of rhinoviruses/enteroviruses and parainfluenza that have already been reported this year.

RSV, influenza, COVID have subtly different symptoms.

While RSV, COVID, and influenza are all viral infections that cause acute respiratory symptoms, they can present with subtly different symptoms. The […]

2022-11-07T11:09:33-05:00November 7th, 2022|infectious diseases, Nursing, pediatrics, Public health|0 Comments
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Do Unto Others: Caring for Patients with Traumatic Brain Injuries

When I was 12 years old, my dad had an “accident.” I remember the day it happened so very clearly. My sixth grade teacher told me I would be going home with one of my very best friends, Madison, to stay the night at her house. I was as excited as any preteen is when they learn they get to have a sleepover on a school night!

When we got home from school, I asked Madison’s mom why we got to have a sleepover. “Your parents are taking a little siesta,” she said. I simply thought this meant that they had gone on vacation without us. Instead, siesta was a code word. My dad was in a coma after suffering a traumatic brain injury (TBI).

The long road to rehabilitation after a TBI.

If you have any experience with TBIs, you know the recovery is often just as traumatic as the injury itself. I think of the accident often, especially when I start my shift. I sit in the parking lot remembering what it was like to be on the other side of TBI rehabilitation.

All of […]

2022-04-18T18:07:02-04:00April 18th, 2022|Nursing|0 Comments
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As Another Coronavirus Begins to Spread, Follow Reasonable Precautions and Avoid Fear-Mongering

(Editor’s note: Published January 24. The situation has considerably changed in the intervening weeks, during which the virus has rapidly spread across the globe. We obviously now know a great deal more about the dangers it presents.)

Emerging infections are part of our world—more evident these days because we have the tools and global communication networks to quickly identify them. This month, we’ve begun another crash course in the initial management of a new pathogen.

Short timeline from first cases to screening test availability.

Rumors of a concerning cluster of undiagnosed pneumonia in Wuhan, China, surfaced on social media on December 31. The patients weren’t responding to antibiotic therapy, but tests were negative for the usual viral suspects. World Health Organization staff quickly connected with Chinese health officials and testing and epidemiological investigations kicked into high gear.

Many of the infected patients had worked at a fish and live animal market in Wuhan, suggesting that the illnesses might be zoonotic (passing from animals to human) in origin. On January 7, the pathogen was identified as a new coronavirus, related (though not closely) to the coronaviruses that cause SARS and MERS. The viral genome was quickly sequenced, and on January 12, China shared the genetic sequence with the global scientific community. By January […]

2020-03-19T17:12:45-04:00January 24th, 2020|infection control, infectious diseases, Nursing, Public health|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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