Should Contact Precautions for Multidrug Resistant Organism Transmission Be Used?

Abstract

There is an increasing incidence on morbidity and mortality related to endemic multi-drug resistant organism (MDRO) like methicillin-resistant Staphylococcus aureus (MRSA), or extended spectrum beta-lactamase (ESBL) enterobacteria. MDRO originated from multiple roots, either endogenous acquisition with selection of spontaneously resistant strains, or exogenous acquisition from skin contact, mostly hand related. The primary acquisition mode for patients in intensive care is endogenous. ESBL producing organisms pose challenging infection control issues, and require searching for new interventions. In order to fight cross-transmission, different strategies can be implemented gradually. Standard precautions apply anywhere and anytime. Contact precautions are also widely recommended for MDRO. However, conflicting data exist regarding their effectiveness and potential link to multiple adverse effects. Recommendations do not match for consensus, but they all focus on contact precautions relief opposing the tightening up of standard precautions, decreasing differences between both. Multiple targets are necessary to minimize nosocomial or community-acquired MDRO colonization or infection. Hence, latest recommendations lean toward a more responsible and rational use of contact isolation, consistent with bacterial virulence or epidemiologic situation. Many strategies must be restricted, like unconditional glove usage. Furthermore, antibiotic use must be rationalized and tightly supervised, in order to better control the spread of MDRO.