As we’ve discussed here previously, multidrug-resistant Gram negative rods (MDR-GNRs) are emerging in many hospitals as the major MDRO problem. This month’s ICHE has several interesting articles on MDR-GNRs, including another study by Erika D’Agata’s group in Boston on the high rate of MDR-GNR carriage among long term care facility residents (I previously highlighted this study by the same group). The rate of MDR-GNR carriage among residents of this LTCF was twice as high as that of MRSA (23%, vs. 11%), and VRE were virtually absent. There are other studies in this issue on KPC-producers and carbapenem-resistant Acinetobacter (both from Penn), and on Stenotrophomonas maltophilia pneumonia.
I expect (and hope) that the inane MRSA active surveillance debate will become increasingly irrelevant as more hospitals learn they can reduce MRSA without active surveillance, and as they begin facing the MDR-GNR problem….unless, of course, we all assume that the universal active surveillance paradigm is essential to controlling all of our MDR-GNRs as well! Let’s see, now all we need are simple, rapid, sensitive tests that can detect carriage of all known MDR-GNR phenotypes.
Good luck with that!
Friday, November 20, 2009
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Even if there was a magic mdr-gn test, where would we swab? Sputum, peri-rectal, groin, wound, axilla or some magic combination? Perhaps we can dunk all patients in a culture-juice bag once a week? Oh well at least OSHA can't mandate how we treat patients yet.
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