Active screening for multiresistant Enterobacteriaceae

The control of multiresistant organisms (MROs) is made difficult by a large reservoir of unrecognised, asymptomatic colonised patients. Hence, active screening is generally used as part of a multifaceted infection control intervention. Active screening for multiresistant Gram-negative bacteria (MRGNB) involves collection of screening specimens from patients with relevant risk factors. Positive results may result in institution of contact precautions, cohorting of patients and enhanced cleaning and surveillance. Active decolonisation is used for some Gram-positive bacteria (e.g. Staphylococcus aureus) but is not thought effective for Gram-negative bacteria, especially those in which resistance is highly transmissible (e.g. plasmid-borne). Accurate and rapid identification of positive specimens allows prompt intervention to interrupt the transmission cycle, and exclusion of MRO colonisation reduces the adverse impact on patient care and hospital workflow. Knowledge of MRO status may also improve the appropriateness of empiric antibiotic prescribing1.