title: Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals.
abstract: BACKGROUND
  Multidrug-resistant Enterobacteriaceae (MDE) are a major public health threat due to international spread and few options for treatment. Furthermore, unlike meticillin-resistant Staphylococcus aureus (MRSA), MDE encompass several genera and multiple resistance mechanisms, including extended-spectrum beta-lactamases and carbapenemases, which complicate detection in the routine diagnostic laboratory. Current measures to contain spread in many hospitals are somewhat ad hoc as there are no formal national or international guidelines.
  
  
  OBJECTIVE
  We sought to establish what should be the priorities for the prevention and control of MDE and what is feasible for implementation. We also identify areas for further research.
  
  
  METHODS
  We reviewed the published literature and other sources e.g. national agencies, for measures and interventions used to control MDE.
  
  
  RESULTS
  Certain categories of at risk patients should be screened, especially in critical care areas, using appropriate laboratory methods. Standard and contact precautions are essential and hand hygiene compliance requires continued emphasis and high compliance levels. As MDE may persist on environmental surfaces for weeks, environmental decontamination could also be an effective control intervention. There are limited options for decolonisation with inadequate studies to date and antibiotic stewardship within and outside the hospital remains important.
  
  
  CONCLUSIONS
  As there is a clear deficit in the evidence base to infor guidance on prevention and control, research in key areas, such as rapid detection, is urgently required.
authors.affiliation: Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: A S
authors.initials: AS
authors.lastname: Khan
authors.forename: S J
authors.initials: SJ
authors.lastname: Dancer
authors.forename: H
authors.initials: H
authors.lastname: Humphreys
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents