Strategies for Combating MDROs: Management and Policy Measures

Multidrug-resistant organisms (MDROs) are among the most pressing health threats of our time. These are bacteria that have developed resistance to multiple classes of antibiotics, making common infections far harder – and sometimes impossible – to treat. Every year, nearly 5 million deaths globally are associated with antimicrobial resistance (AMR). The good news? A combination of smart antibiotic use, rigorous infection control, coordinated global policy, and vaccination can significantly slow the spread of MDROs. Let’s break down the key management and policy strategies driving this effort.

Antibiotic stewardship: using antibiotics the right way 🔗

At the heart of combating MDROs is antibiotic stewardship – the coordinated effort to ensure antibiotics are prescribed and used appropriately. Every time an antibiotic is used, whether necessary or not, it creates selective pressure that can drive resistance. Stewardship programs aim to ensure patients receive the right antibiotic, at the right dose, for the right duration.

What does stewardship look like in practice? 🔗

The CDC’s Core Elements of Antibiotic Stewardship provide a framework for hospitals, nursing homes, outpatient clinics, and even health departments to structure their stewardship efforts. These core elements include having dedicated leadership committed to improving antibiotic use, implementing policies to guide prescribing, tracking antibiotic use and resistance patterns, and regularly reporting outcomes back to clinicians.

Stewardship isn’t just a hospital concern. In the outpatient setting – where the majority of antibiotics are prescribed – the challenge is equally significant. In 2024, the overall U.S. outpatient antibiotic prescribing rate was 752 prescriptions per 1,000 people, a modest 1% decline from the previous year. While that trend is heading in the right direction, it highlights how much work remains. Many prescriptions written for viral respiratory infections like colds and flu are still unnecessary.

Key principles of responsible antibiotic use 🔗

Effective stewardship centers on several principles. Clinicians should treat infections rather than contaminants, choose narrow-spectrum agents when possible, avoid excessively long treatment courses, and reserve broad-spectrum antibiotics for serious infections where the pathogen is unknown. Audit-and-feedback programs – where clinicians receive data on their own prescribing patterns compared to guidelines – have proven effective at changing behavior.

Dental and outpatient settings deserve special attention. Despite the release of updated prescribing guidelines, antibiotic prescribing by general dentists has remained relatively stable, and dentists now account for more than 10% of all outpatient antibiotic prescriptions in the United States. This underscores the need to extend stewardship education and tools well beyond hospital walls.

Infection control protocols: stopping MDROs at the source 🔗

Even the best antibiotic stewardship won’t eliminate MDROs if these organisms continue to spread within healthcare facilities. That’s where infection prevention and control (IPC) comes in. Hospitals, nursing homes, and other healthcare settings are high-risk environments for MDRO transmission, given the concentration of vulnerable patients and frequent use of invasive devices like catheters and ventilators.

Hand hygiene: the single most important measure 🔗

It may sound simple, but hand hygiene is widely recognized as the most important intervention for preventing the spread of MDROs. The WHO’s guidelines outline five critical moments for hand hygiene: before patient contact, before performing clean or aseptic procedures, after exposure to body fluids, after patient contact, and after contact with the patient’s surroundings.

Despite this, compliance remains a persistent challenge. Studies have shown that hand hygiene adherence by healthcare workers can be startlingly low. In one large study at a New York City hospital network, hand hygiene rates upon entering patient rooms were as low as 19.4%. However, facilities that invest in multimodal improvement strategies – including education, reminders, feedback, and accessible alcohol-based hand rubs – have achieved significant and sustained improvements in compliance and reductions in MDRO infections.

Contact precautions and isolation 🔗

For patients known or suspected to be colonized or infected with MDROs, contact precautions are a standard recommendation. This means healthcare workers wear gloves and gowns before entering the patient’s room, and dedicated equipment (like stethoscopes and blood pressure cuffs) is used to prevent cross-contamination. In some settings, patients may be placed in private rooms or cohorted with others carrying the same organism.

The CDC’s guidelines for MDRO management describe seven categories of interventions that healthcare facilities can use: administrative support, judicious antimicrobial use, surveillance (both routine and enhanced), standard and contact precautions, environmental measures, education, and decolonization. Successful MDRO control programs typically combine several of these strategies rather than relying on any single measure.

Environmental cleaning and disinfection 🔗

MDROs can survive on hospital surfaces for extended periods, making environmental cleaning a critical line of defense. Advanced disinfection technologies, including ultraviolet (UV) light and hydrogen peroxide vapor, have shown promise in reducing MDRO contamination on surfaces. A 2024 review of MDRO prevention literature confirmed that enhanced environmental disinfection techniques can meaningfully reduce transmission when combined with other interventions like hand hygiene monitoring and feedback.

Active surveillance cultures 🔗

Many facilities also employ active surveillance cultures (ASC) – screening patients upon admission or transfer for MDRO colonization, even before symptoms appear. Early identification allows targeted precautions to be implemented immediately, preventing silent transmission to other patients. This approach has been particularly effective during outbreaks of organisms like MRSA and VRE in intensive care units.

Global and national policies: coordinating the fight against AMR 🔗

Antimicrobial resistance doesn’t respect borders. A resistant organism that emerges in one country can spread worldwide through travel, trade, and migration. That’s why coordinated global and national policies are essential to the fight against MDROs.

The WHO Global Action Plan on Antimicrobial Resistance 🔗

In 2015, the World Health Assembly endorsed the WHO Global Action Plan (GAP) on Antimicrobial Resistance. This plan established five key objectives: improving awareness and understanding of AMR, strengthening surveillance and research, reducing infections through better sanitation and hygiene, optimizing antimicrobial use, and making the economic case for sustainable investment in new medicines and diagnostics.

Since then, progress has been substantial. Over 178 countries have developed multisectoral national action plans aligned with the GAP, and more than 100 countries now report surveillance data through the Global Antimicrobial Resistance and Use Surveillance System (GLASS). In September 2024, the UN General Assembly held its second High-Level Meeting on AMR, where world leaders adopted a political declaration committing to reduce AMR-associated human deaths by 10% by 2030.

The plan is also being updated. In May 2025, the 78th World Health Assembly approved a decision to develop GAP-AMR 2.0, an updated version for discussion at the 2026 World Health Assembly that will provide a practical framework for the next decade.

National-level action and the One Health approach 🔗

Effective AMR policy requires a One Health approach – recognizing that human health, animal health, and the environment are deeply interconnected. Antibiotic overuse in livestock farming, for instance, contributes to the same resistance pressures that affect human medicine. National action plans therefore ideally span all these sectors.

In the United States, CDC has invested heavily in stewardship infrastructure. Through the American Rescue Plan Act, more than $120 million was provided to 62 state and local health departments to support stewardship expertise and activities. By 2021, 95% of U.S. hospitals had implemented all seven core elements of antibiotic stewardship – a dramatic increase from just 41% in 2014.

At the European level, the European Centre for Disease Prevention and Control (ECDC) maintains a directory of national strategies and action plans, helping coordinate regional efforts. Countries across Europe, Asia, Africa, and the Americas continue to refine their national action plans with updated targets and evidence-based interventions.

Vaccination and public awareness: prevention as a first line of defense 🔗

One of the most underappreciated tools in the fight against MDROs is vaccination. Vaccines don’t just prevent the target infection – they reduce the overall need for antibiotics, which in turn slows the development of resistance.

The impact of vaccines on AMR 🔗

A landmark 2024 report by WHO found that vaccines targeting 24 pathogens could reduce global antibiotic use by 22%, equivalent to 2.5 billion daily doses every year. The report assessed 44 vaccines – some already licensed and others in development – and concluded that vaccines could have prevented roughly 515,000 of the AMR-associated deaths that occurred in 2019.

Vaccines already in widespread use are making a difference. Pneumococcal conjugate vaccines, for example, protect against drug-resistant pneumonia and could save tens of millions of antibiotic doses annually if coverage reached global targets. In the United States, newer formulations (PCV15 and PCV20) recommended for children and adults could reduce up to 700,000 antibiotic prescriptions for respiratory infections among U.S. children alone.

Vaccines in development hold even greater promise. A future tuberculosis vaccine administered to adolescents could prevent an estimated 71,000 AMR-associated deaths and save over 1 billion antibiotic doses annually. Maternal vaccines targeting Klebsiella pneumoniae, currently in early clinical development, could protect newborns from deadly drug-resistant bloodstream infections.

Public awareness campaigns 🔗

Vaccines can only work if people use them, and antibiotics can only be steered responsibly if the public understands the risks of misuse. That’s why public health campaigns play a vital role in the broader AMR strategy.

The CDC’s Be Antibiotics Aware campaign has been running continuous paid advertisements since late 2023, reaching millions of people with messages about when antibiotics are – and aren’t – necessary. WHO’s annual World Antimicrobial Awareness Week similarly raises the profile of AMR among both healthcare professionals and the general public worldwide.

Effective awareness campaigns do more than share information. They aim to change behavior – discouraging patients from pressuring doctors for unnecessary prescriptions, encouraging completion of prescribed courses, and building understanding of why resistant infections are a threat to everyone, not just hospital patients.

Bringing it all together 🔗

No single strategy can defeat MDROs on its own. The most effective approach is a layered one – antibiotic stewardship to optimize drug use, infection control protocols to interrupt transmission in healthcare settings, global and national policies to coordinate action across borders and sectors, and vaccination combined with public education to prevent infections before they occur. Each of these pillars reinforces the others.

The progress made in the past decade is real – more countries have action plans, more hospitals have stewardship programs, and new vaccines are in development. But AMR-associated deaths remain unacceptably high, compliance with basic measures like hand hygiene still falls short in many settings, and low- and middle-income countries continue to bear a disproportionate burden. The targets set by the UN – a 10% reduction in AMR-associated deaths by 2030 – are achievable, but only with sustained commitment and investment from governments, healthcare systems, and communities worldwide.

What do you think? How can healthcare facilities better ensure compliance with infection control measures like hand hygiene among all staff? And should governments mandate antibiotic stewardship programs in all healthcare settings, or are voluntary approaches sufficient?

References

1. https://www.who.int/publications/m/item/global-call-to-action-to-address-antimicrobial-resistance
2. https://www.cdc.gov/antibiotic-use/hcp/core-elements/index.html
3. https://www.cdc.gov/antibiotic-use/hcp/data-research/stewardship-report.html
4. https://www.cdc.gov/antibiotic-use/media/pdfs/2023-stewardship-report.pdf
5. https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/infection-prevention-and-control/mdro-literature-review.pdf
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC2827623/
7. https://www.cdc.gov/infection-control/hcp/mdro-management/prevention-control.html
8. https://pmc.ncbi.nlm.nih.gov/articles/PMC10817162/
9. https://www.who.int/publications/i/item/9789241509763
10. https://www.who.int/news/item/27-05-2025-seventy-eighth-world-health-assembly—daily-update–27-may-2025
11. https://www.cdc.gov/antibiotic-use/php/core-elements/health-departments/index.html
12. https://www.ecdc.europa.eu/en/publications-data/directory-guidance-prevention-and-control/antimicrobial-resistance-strategies
13. https://www.who.int/news/item/10-10-2024-better-use-of-vaccines-could-reduce-antibiotic-use-by-2.5-billion-doses-annually–says-who
14. https://cdc.gov/antimicrobial-resistance/stories/experts-discuss-role-of-vaccines.html