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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Chagas: An Unfamiliar and Emerging Disease

Ms. Stevens is a 32-year-old humanitarian aid worker. She recently returned to the United States after spending a month volunteering in rural Guatemala, where she was assisting with community housing construction. She reports having had multiple insect bites during her stay and occasional insects in her sleeping quarters. Six months after returning to the U.S., she developed intermittent low-grade fevers, malaise, and mild right eyelid swelling.

Chagas disease—also called American trypanosomiasis—is a potentially life‑threatening infection caused by the parasite Trypanosoma cruzi. The parasite is transmitted primarily through contact with an infected “kissing bug.” Transmission occurs when an infected bug feeds at night and defecates near the bite.

The bitten individual scratches or rubs the bite site and enables the parasites to enter the skin, or the eyes if rubbed. Other transmission routes include congenital (mother‑to‑fetus), blood transfusion, organ transplantation, laboratory accidents, and foodborne outbreaks from contaminated juices or foods. Illness has an acute phase that is often mild or asymptomatic and a chronic phase that can manifest decades later with a variety of cardiac and gastrointestinal symptoms.

Global and U.S. epidemiology

WHO map of global Chagas case distribution (based […]

2025-11-07T15:01:57-05:00November 7th, 2025|infectious diseases, Nursing, Public health|0 Comments
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Turmoil at the CDC Endangers Public Health

Sowing distrust in the science behind CDC guidance.

The turmoil roiling the Centers for Disease Control and Prevention (CDC) was on full view last Thursday at the Senate hearing convened to review the Trump administration’s health care agenda. The proceedings quickly descended into a shouting match as senators, both Republican and Democrat, challenged health secretary Robert F. Kennedy Jr. on his policies and recent actions, particularly regarding vaccines and the firing of CDC director Susan Monarez. Kennedy defended his positions while attacking the agency, as he has done repeatedly, accusing its medical experts and scientists of corruption and collusion with the pharmaceutical industry.

In late August, Kennedy called Monarez into his office and pressured her to resign, a mere 29 days after appointing her. At the time of her appointment, Kennedy lauded Monarez as “a public health expert with unimpeachable scientific credentials,” stating that he had “full confidence in her ability.”

Photo credit: Shutterstock

According to White House press secretary Karoline Leavitt, Monarez was fired […]

2025-09-12T09:50:13-04:00September 12th, 2025|COVID-19, infection control, infectious diseases, Nursing, Public health|0 Comments
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Ticks and Tick-Borne Diseases: A Comprehensive Nursing-Focused Overview

Virtually all of us who have spent time in the outdoors have either heard about or experienced an encounter with a tick. Diseases transmitted through the bite of a tick represent a growing health concern in the United States and around the world. Tick bites can affect individuals who live in, work in, or travel to wooded, grassy, or brush-filled environments. Ticks are generally more active during warmer months of the year (usually April through September), but they can be active any time the temperature is above freezing. Therefore, taking precautions can be close to a year-round activity, including an increased emphasis during vacation travel when the climate may differ from that of your usual environment. Nurses play an essential role in patient education, prevention, early recognition, clinical management, and public health surveillance of these diseases—and their credibility and trusted relationships enable impactful opportunities.

Adult deer tick, Ixodes scapularis/via Wikimedia Commons

The following summary outlines key facts about tick biology and transmission, clinical manifestations of major tickborne diseases [TBDs], prevention strategies, post-bite care, public health reporting, and updates on vaccines—particularly for domestic and international travelers.

Understanding ticks and disease transmission

Ticks are blood-feeding arachnids capable of transmitting pathogens, including bacteria, viruses, and protozoa, […]

2025-08-25T11:04:09-04:00August 25th, 2025|infection control, infectious diseases, Nursing, Public health|0 Comments
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Kennedy’s Replacement of Entire Vaccine Advisory Committee Causes Widespread Alarm

Heather Hazzan, SELF Magazine

Department of Health and Human Services (HSS) Secretary Robert F. Kennedy Jr. has fired all 17 members of the Advisory Committee for Immunization Practices (ACIP), the body of experts that reviews vaccine safety and efficacy data and makes recommendations on vaccine scheduling as well as precautions and contraindications to the Centers for Disease Control and Prevention (CDC).

In a June 9 news release, HHS announced the dismissals, claiming it as a “bold step to restore public trust in vaccines.” In a post the next day on the social media platform X, Kennedy accused the committee of financial corruption and of “malevolent malpractice” for allegedly not requiring placebo-controlled trials for childhood vaccines, a misleading and inaccurate claim he has made frequently in the past.

Refuted and misleading claims.

In a May ‘Fact-Checked’ news release, the American Academy of Pediatrics (AAP) refuted his claims, stating that most childhood vaccines were tested originally in randomized clinical trials that included placebo or comparison groups. AAP also noted that when testing a replacement for an existing vaccine, the comparator is the existing vaccine, not an inert placebo, because “when a safe, effective vaccine already exists against a […]

2025-06-13T08:31:49-04:00June 13th, 2025|COVID-19, infectious diseases, Nursing, pediatrics, Public health|0 Comments
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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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