Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals

Background: Multidrug-resistant Enterobacteriaceae (MDE) are a major public health threat due to international spread and few options for treatment. Furthermore, unlike meticillin-resistant Staphylococcus aureus (MRSA), MDE encompass several genera and multiple resistance mechanisms, including extended-spectrum beta-lactamases and carbapenemases, which complicate detection in the routine diagnostic laboratory. Current measures to contain spread in many hospitals are somewhat ad hoc as there are no formal national or international guidelines.

Aim: We sought to establish what should be the priorities for the prevention and control of MDE and what is feasible for implementation. We also identify areas for further research.

Methods: We reviewed the published literature and other sources e.g. national agencies, for measures and interventions used to control MDE.

Findings: Certain categories of at risk patients should be screened, especially in critical care areas, using appropriate laboratory methods. Standard and contact precautions are essential and hand hygiene compliance requires continued emphasis and high compliance levels. As MDE may persist on environmental surfaces for weeks, environmental decontamination could also be an effective control intervention. There are limited options for decolonisation with inadequate studies to date and antibiotic stewardship within and outside the hospital remains important.

Conclusion: As there is a clear deficit in the evidence base to infor guidance on prevention and control, research in key areas, such as rapid detection, is urgently required.