Monday, August 6, 2012

Evidence Based Control of Multi-Drug Resistant Enterobacteriaceae Needed

Source: CDC
Here is a publication on the need for evidence based policies to limit and control multi-drug resistant enterobacteriaceae (MDE) in hospitals. Much of our strategies to currently control MDE is ad hoc and not fully driven by high quality evidence or formal guidelines. 

Noteworthy points include:

  • The degree of transmissibility of MDE is unclear, hence further work is required to better understand where, when and how transmission occurs
  • The optimal screening frequency has yet to be determined.
  • There is no consensus on how long patients may carry MDE, thus the freqency of re-screening is unknown
  • Although oral gentamicin for decolonization of MDE has been reported, optimal strategies for decolonization of MDE do not exist
  • Environmental decontamination strategies and antibiotic stewardship (restriction of extended spectrum cephalosporins in particular) may also be effective interventions to limit the spread and appearance of MDE.

As we gather more experience on the control of MDE, attention must be given to both the positive and negative consequences of our infection prevention interventions.  The example MRSA active surveillance and its pros/cons is insightful and underscores a look before you leap approach.   

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