Screening for Multidrug Resistant Bacteria: For Which Patients?

Abstract

Active surveillance screening (ASC) of patients hospitalized in intensive care units (ICU) or elsewhere searching for carriers of multidrug-resistant bacteria (MDRB) remains controversial. Available guidelines are discordant. Current French recommendations emphasize standard precautions as the principal control measure against endemic MDRB, complemented by specific measures according to the epidemiology of each species, i.e., possible decontamination of methicillin-resistant Staphylococcus aureus (MRSA) carriers, and special attention to the handling of secretions and excreta for the extended-spectrum beta-lactamase producing enterobacteriaceae (ESBL-PE). In the current endemic setting which prevails in most European countries, screening and isolation of carriers of these two MDRB has no added benefit over optimal observance of standard precautions, in the absence of outbreak. Conversely, ASC is justified for the control of outbreaks and control of the highly-resistant bacteria which have recently emerged, and are still rarely encountered in most settings. In France, these highly-resistant bacteria include carbapenem-resistant enterobacteriaceae and glycopeptide-resistant enterococci. Carbapenem-resistant Acinetobacter warrant the same approach in the ICU. Infection control efforts to prevent cross-transmission must be complemented by a strict antimicrobial stewardship for optimal effectiveness of the control program.