Now that I have your attention, let’s talk about the greatest emerging antibiotic resistance challenge in healthcare settings: multiply drug resistant gram negative rods (MDR-GNRs). Reports keep coming in about the alarming rates of MDR-GNR carriage and infection in long term care facilities (LTCFs). I just ran across one in a journal I don’t often read, the Journal of Gerontology. This study, by Erika D’Agata’s group in Boston, found that MDR-GNRs (defined in this study as resistant to 3 or more antibiotic classes) were more prevalent in clinical cultures than were MRSA or VRE at one large LTCF in Boston. Another recent report from Anthony Harris’ group in Maryland found that carriage of Acinetobacter baumannii was more common than MRSA among long-term acute-care residents.
Compared with the MDR-GNR universe, MRSA is very simple: one gene (mecA), one altered target, one resistance phenotype. For MDR-GNR? Not so much. Detection and prevention approaches remain a tremendous challenge, which is why Acinetobacter outbreaks are more likely to require closure of units to new admissions than are outbreaks due to any other organism.
In this context, I think what we really need are more laws that force hospitals to focus their antibiotic-resistance prevention resources on MRSA. Don’t you agree?