Identifying Antibiotic-Resistant Bacteria in Hospitalized Patients: What Is the Role of Active-Surveillance Cultures?

Abstract

Antibiotic-resistant bacteria are an important cause of morbidity and mortality among hospitalized patients throughout the world. Controlling the emergence and spread of these organisms in healthcare settings requires multiple strategies, including strict attention to hand hygiene, vigilant disinfection of equipment and the environment, efforts to promote antimicrobial stewardship, and adherence to evidence-based bundles of care practices to prevent infections associated with the use of invasive devices such as central venous catheters and ventilators. Multiple studies have demonstrated that identification of patients who are colonized with organisms such as methicillin-resistant Staphylococcus aureus (MRSA)7 and vancomycin-resistant enterococci (VRE), in conjunction with the use of contact precautions when caring for those who are colonized, can reduce rates of colonization and infection with these bacteria. Active-surveillance cultures (ASCs) for these organisms are currently recommended for hospitalized patients at high risk of carriage. Questions remain, however, regarding which specific populations should be screened, the optimal screening method, and which organisms should be targeted for ASC. In this Q&A, 5 experts with different roles in infection prevention and microbiology [including adult (S.S.H.) and pediatric (A.M.M.) hospital epidemiologists from the US and Europe (S.H.), an infection preventionist (S.A.D.), and a microbiology laboratory director (A.J.M.)] have been asked to comment on several unresolved issues regarding the use of ASC as a strategy to prevent the transmission of multidrug-resistant organisms (MDROs) in hospitals. The 2006 Healthcare Infection Control Practices Advisory Committee guideline for the management of MDROs in healthcare settings notes that the target populations for ASC are not well defined. In what patient populations do ASCs make the most sense, and why are there differences between the “search and destroy” approach used in Europe and what is typically done in the United States? Susan Huang: ASC has been shown to be beneficial in high-risk hospitalized populations where …