TO THE EDITOR:
Some of the measures outlined in the recent article by Edmond and colleagues [1] appear to be misplaced and ignore experience with methicillin-resistant Staphylococcus aureus. Boyce and colleagues [2] extensively reviewed the literature on methicillin-resistant S. aureus and emphasized moderate reaction in the absence of proven benefit or more extreme measures and found no evidence of either airborne or fomite transmission. Their observations should serve as a warning to those who advocate extreme control measures for vancomycin-resistant S. aureus in the absence of any experience with the organism. Sampling of surfaces in the room of the patient infected or colonized with vancomycin-resistant S. aureus after discharge also conflicts with recommendations from the Centers for Disease Control and Prevention. Reliance on mupirocin for topical decolonization without information on antimicrobial susceptibility might also promote additional microbial resistance. In dealing with an outbreak of vancomycin-resistant enterococci, other investigators [3] found that routine surveillance cultures were of little value and that vancomycin-resistant enterococci persisted despite use of contact precautions.
We advocate improved compliance with hand washing and more prudent use of antibiotics. These interventions would also reduce selection and transmission of other antibiotic-resistant microorganisms. Recent strategies [4] advocate an individualized approach for health care facilities. We encourage extension of this approach throughout the health care industry.
The measures suggested by Edmond and colleagues also contain an extensive procedure for processing clinical specimens from patients with vancomycin-resistant S. aureus. These seem to be contrary to those already recommended for clinical microbiology laboratories [5]. We are not aware of data that show the need for additional measures within the laboratory to control spread of S. aureus, and we therefore ask the authors for the rationale behind their recommendation that such facilities be used for vancomycin-resistant S. aureus. Although vancomycin-resistant S. aureus is a legitimate threat, its potential emergence should not lead us to ignore what we have learned about staphylococcal virulence or epidemiology.
1. Edmond MB, Wenzel RP, Pasculle AW. Vancomycin-resistant Staphylococcus aureus: perspectives on measures needed for control. Ann Intern Med. 1996; 124:329-34.
2. Boyce JM, Jackson MM, Pugliese G, Batt MD, Fleming D, Garner JS, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. The AHA Technical Panel on Infections within Hospitals. Infect Control Hosp Epidemiol. 1994; 15:105-15.
3. Wells CL, Juni BA, Cameron SB, Mason KR, Dunn DL, Ferrieri P, et al. Stool carriage, clinical isolation, and mortality during an outbreak of vancomycin-resistant enterococci in hospitalized medical and/or surgical patients. Clin Infect Dis. 1995; 21:45-50.
4. Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA. 1996; 275:234-40.
5. Strain BA, Groschel DH. Laboratory safety and infectious waste management. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolker RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology; 1995:75-85.
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