Interventions to prevent transmission of antimicrobial-resistant bacteria in the intensive care unit

PURPOSE OF REVIEW: Healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), and multidrug resistant Gram negative bacilli are a serious problem in ICUs. This review analyzes recent reports of interventions to prevent transmission of these organisms in the ICU. RECENT FINDINGS: Two multicenter retrospective cohort studies demonstrated that surveillance cultures are necessary to identify the full reservoir of patients colonized with MRSA or VRE. A single center, interrupted time series study found that the incidence of healthcare-associated MRSA bacteremia was reduced after initiation of MRSA surveillance cultures. Other studies with various designs describe the effect of active surveillance on the use of isolation precautions, sustained improvements in compliance with hand hygiene and glove use associated with a multimodal intervention, reduced transmission of VRE associated with chlorhexidine bathing and improved environmental cleaning, and the efficacy of a MRSA decolonization regimen. SUMMARY: Progress is being made in identifying interventions to prevent transmission of antimicrobial resistant bacteria in ICUs, although the strength of the evidence is limited compared with many therapeutic interventions. Large MRSA control initiatives launched during 2006 and 2007 may build on this work; their effects should be evaluated using proper study designs and analyses.