We agree with Drs. Olmsted and Lundstrom and their colleagues that strict compliance with hand washing and prudent use of antimicrobial agents are important in preventing the selection of organisms that are resistant to antibiotics and in controlling the nosocomial transmission of these organisms. We acknowledged that some of our recommendations for the control of vancomycin-resistant S. aureus were based on limited data. Nonetheless, our concerns for airborne transmission of the organism have been emphasized further in the recent study by Sherertz and colleagues [1]. These investigators showed that a surgeon with nasal colonization of S. aureus who had a viral infection of the upper respiratory tract dispersed S. aureus into the air. His S. aureus isolate was recovered on settle plates placed as far as 6 feet away. Moreover, recovery of organisms from settle plates was significantly reduced when the surgeon wore a mask.

We appreciate the observations of Dr. Vandenbroucke-Grauls and find it interesting that in the Netherlands, where measures for controlling methicillin-resistant S. aureus are stricter, the incidence of methicillin-resistant S. aureus is much lower than it is in the United States. Hospitals in the United States that have developed rigorous programs for control of methicillin-resistant S. aureus have observed similar lower rates of methicillin resistance among S. aureus isolates.

Although we recommended that certain diagnostic procedures for patients who are colonized or infected with vancomycin-resistant S. aureus be postponed when possible, we do not advocate withholding appropriate care.

Infection with organisms acquired in the laboratory does occur. Because infection with vancomycin-resistant S. aureus could be fatal for a laboratory worker, we believe it is imperative to maximize efforts to protect these workers. Although no evidence suggests that laboratory workers become colonized by organisms with which they work, there is also no evidence that they do not.

We maintain our view that the implications of the emergence of vancomycin-resistant S. aureus are so alarming that we must use extreme measures until more is learned about the epidemiology of the transmission of this organism. To do otherwise may allow this organism to become an endemic nosocomial pathogen, following in the path of methicillin-resistant S. aureus and vancomycin-resistant enterococci.