Infection prevention and control strategies for multidrug-resistant Gram-negative bacteria in healthcare: a narrative review.

Antimicrobial-resistant Gram-negative bacilli (AMR GNB) are associated with poor patient outcomes, are increasing in prevalence and are recognized by national and international public health authorities as a major threat to human health. The most common resistance elements vary by organism, but resistant Enterobacterales, Pseudomonas and Acinetobacter species have reservoirs in the human colon, natural environment and healthcare settings. Persistence of these organisms on inanimate surfaces contributes to the risk of bacterial transmission in healthcare settings. Standard infection prevention practices including hand hygiene, low-level disinfection and use of isolation precautions are effective in interrupting transmission of AMR GNB. However, the optimal use of isolation precautions is an area of active reconsideration and research. High-risk equipment, such as duodenoscopes, can be difficult to disinfect and has been associated with hospital transmission. The immunocompromised and critical care populations are at higher risk of infection and may benefit from additional infection control interventions. Innovative approaches to reduce healthcare transmission have included screening surveillance with the use of isolation or decolonization protocols, but these approaches require further study. Antimicrobial stewardship remains a key strategy to reduce the pressure to select for AMR GNB in healthcare settings and the general environment. Low-resource settings can implement existing World Health Organization infection prevention tools to reduce transmission of AMR GNB infections. Although implementation of existing infection prevention and antimicrobial stewardship strategies can limit transmission of AMR GNB infections, development of new approaches is needed to curb increasing prevalence of AMR GNB.