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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AJN’s 2025 Book of the Year Awards and Other Highlights of the January Issue

The January issue of AJN is now live.

AJN’s 2025 Book of the Year Awards can be found in the the current issue. Browse judges’ choices in a wide variety of categories.

On this month’s cover is Eyes of Gold 2 [Children of The Sun With Moon Crescent Blood], a work by artist Rizzy Akanji, creative director of Akanji Studio—a London-based art and storytelling house that “uses visual art, poetry, and creative education to raise awareness for sickle cell disorder and to transform lived experiences of pain into expressions of power and beauty.”

Below are articles from the January issue we’d like to draw your attention to:

A review article (CE credit available), “Sickle Cell Disease: Treatment Options of the Past, Present, and Future,” gives an up-to-date overview of what every nurse will want to know about this challenging and painful condition.

“Exploring Retention Among Army Nurses: A Qualitative Study” is an open access original research article based on the authors’ interviews with active-duty Army nurses. It identifies two key priorities that emerged from interviews and subsequent analysis as to why nurses choose to stay.

The second original research article in our January issue is […]

2025-12-30T10:00:09-05:00December 30th, 2025|Nursing|0 Comments
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The Ethical Use of our Therapeutic Connections with Patients’ Families

“What would you do, doctor?” The family had been explicit in wanting straightforward communication about their child, whose neurological disease had progressed to the point where she was continually seizing, despite every medication the physicians had tried. The seizures were in turn damaging her brain, such that she was minimally responsive to stimuli and was not expected to regain significant awareness of her surroundings.

I held my breath as I anticipated the doctor’s reply. She had spent many hours with this patient and family, and had built trust with the parents.

“As a physician . . . I would transition my child to comfort care and ultimately let her go. But as a mother . . . I would struggle to do this.”

The patient’s mom nodded tearfully. The doctor had given an honest reply, and had still ultimately left the choice to the parents.

I took care of this patient in her final few days of life. The parents were heartbroken but also clear in their decision. We walked them through each step, and made sure they felt supported to the best of our ability, down to their very last goodbye with their child.

******

There is power in the medication and therapies we apply. Fluid and […]

2025-12-18T10:39:59-05:00December 18th, 2025|Ethics, family, family experience, narratives, nursing roles, nursing stories|1 Comment
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Nursing Is Still a Profession — But a New Loan Law Treats It Differently

What new federal “professional degree” loan caps actually mean for graduate nursing students

Over the past few weeks, many nurses have watched headlines and social media posts claim that “Trump made nursing no longer a profession.”

That line is alarming—but it isn’t accurate.

Nursing is still a licensed profession defined by statute, governed by boards of nursing, and recognized by every hospital system in the country. Our scope of practice hasn’t changed. Our credentials haven’t changed. Our professional identity hasn’t changed.

What has changed is a technical federal loan category—one that now places graduate nursing programs in the same bucket as standard academic master’s programs rather than alongside medicine, dentistry, or law. For some future nurses, that shift could affect how they pay for school. For others, the change may barely be noticeable. The details matter, and the math matters even more.

What the Big Beautiful Bill actually changed

In July 2025, Congress passed the One Big Beautiful Bill Act (“OB3”), a sprawling package that, among many things, rewrites portions of the federal student loan system beginning July 1, 2026.

The most significant change for nurses is the elimination of Grad PLUS loans—the program that previously allowed graduate students to borrow up to their school’s full cost of attendance. […]

2025-12-16T10:14:23-05:00December 16th, 2025|Nursing|1 Comment
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The Rise of Anti-Intellectualism, Snapshot of Nursing in Gaza, Video Monitoring to Reduce Falls: December Issue Recommended Reading

The December issue of AJN is now live.

Some articles in this issue will be open access or free to access for a set period; others will require log-in or subscription. Below are some articles of note we’d like to draw your attention to.

This issue has two original research articles. The first is of these is an observational cohort study looking at implementation of a continuous video monitoring program to decrease falls in a long-term acute care hospital setting. This article is open access.

The second original research article in our December issue is “Investigating the Relationships Among Nurses’ Stress, Sleep Quality, and Mental Health, and the Mediating Role of Coping Strategies and Social Support: A Cross-Sectional Study.” According to the authors, “This study highlights strong associations between stress, sleep quality, anxiety, and depressive symptoms, with coping strategies and social support as potential mediators.”

An integrative review (currently free to read) looks at what we currently know (and don’t know but need to study) about best practices for implementing hospital-based virtual nursing.

Our editorial by editor-in-chief Carl Kirton indulges a little word play in its title, “The Rise of AI.” But the topic […]

2025-11-20T11:34:48-05:00November 20th, 2025|digital health, Nursing, nursing research, Public health, Technology|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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