3 MRGN!!

Question

Hello dear expert team,
I am suffering from CF and in my sputum, a 3 MRGN (multi-resistant gram-negative germ against 3 antibiotic classes) germ has been found. What does this mean now for me and can the germ disappear again and what do I have to pay attention to and should this be treated if I am doing rather well, oxygen values o.k. only slightly phlegmy. Should I do an i.v. therapy and can I go to rehabilitation with this germ?
Many thanks

Answer

Dear questioner,
we assume, that you address in your quesiton about the 3 MRGN germ the Pseudmonas aeruginosa (PA) germ. We will answer in connection to PA. In order it should address a different germ, we would have to know the name of the bacterium first.
Your request contains 4 questions:
1. Can a 3MRGN PA that occurred once in the sputum disappaer again?
2. What do you have to pay attention to concerning a 3 MRGN PA?
3. Has a 3 MRGN PA to be treated?
4. Can a Patient with a 3 MRGN PA go to a rehabilitation clinic?
To question No 1:
A 3 MRGN PA can change with a 4 MRGN PA and vice versa and that happens quite frequently. However, it cannot be excluded, that a CF patient, often only temporarily, gets rid of the 3 MRGN PA, and more seldom gets completey rid of it.
To question No2:
The 3 MRGN and the 4 MRGN are mutliresistant germs. In case of CF patients with these germs, special hygienic measures should be respected especially concerning the contact to other CF patients or in case of immuno-suppressed patients (e.g. after transplantation, newborns, tumor patients with chemotherapy). Hereby it deals with a prevention of the possible transmission of germs from human to human. It is especially important to keep attention to clean hands, to disinfect them well, not to cough into the palms and to avoid very close and intimate contact to people in danger.
To question No 3:
A treatment of the 3 MRGN PA is similar to the rules that pertain for PA in general. We are not able to decide about the necessity of an i.v. PA effective therapy in your personal case, as we know too less about you and your course of the illness. Many aspects are involved in the decision: information on the general health status, varying results, the fact, if the PA is overall in your sputum for the first time or is already chronical, the question, if you receive at the moment another PA effective therapy i.a. Therefore we recommend to talk to your CF physician about this. Our remarks can certainly be an aid when talking to your physician.
To question No 4:
At the end of october 2014 we have answered a question concerning a rehabilitation stay in case of a 3 or 4 MRGN. The answer also covers your 4th question. We have given the following answer at that time:
"...unfortunately it is like this, that patients with 3 MRGN and 4 MRGN PA can not be admitted to a rehabilitation clinic according to the actual pertaining hygiene rules. The sole possibility to do an inpatient rehabilitation cure is a climate cure single measure, that can be requested at the Mukoviszidose eV. (German Patient organization). These climate cures are not paid by the health insurance but by donations that are aquired by the Mukoviszidose eV. If you are interested in a climate cure, please contact your physician and the Mukoviszidose eV. With your CF physician you discuss the necessity of a climate cure and with the Mukoviszidose e.V. the detailed process of doing a request. "
I hope to have helped you with my remakrks and stay with my best regards,
Yours Dr. Christina Smaczny

03.01.2015