Editorial Commentary: Control of Multidrug-Resistant Microorganisms: Beyond the Hospital

Abstract

The study by Tschudin-Sutter and colleagues from Basel, Switzerland, in this issue ofClinical Infectious Diseases[1] questions the added value of contact precautions compared with standard precautions to prevent the spread of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E). This observational cohort study covers an important topic, as multidrug-resistant microorganisms are rapidly emerging worldwide, new effective antimicrobial agents are lacking, and the ef!cacy of current strategies to control the spread of resistant microorganisms in hospitals is largely unknown. The group from Basel found a remarkably low ESBL-E transmission rate (1.5%) from nonisolated index patients to roommates, with a mean contact period of 4.4 days. They conclude that nosocomial ESBL-E transmission rates are low when a high level of standard hygiene precautions is applied, and that the community reservoir may be a more important driver in the emergence and spread of ESBL-E, with an emphasis on the food chain. This study has some limitations that are well discussed by the authors. Nevertheless, there are some aspects that deserve a closer look. First, there is the generalizability of the results to other settings. The University of Basel is known to have a highly active and effective infection control program and, consequently, low occurrence rates of infection with methicillin-resistantStaphylococcus aureusand other multidrugresistant microorganisms. During the 11-year study period, the mean annual number of patients colonized or infected with ESBL-E was 90%