Control of Nosocomial Methicillin‐ResistantStaphylococcus aureusInfection

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Abstract
To THE EDITOR—We write to express agreement with the statement of Klevens et al. [1] that, “regardless of which [methicillin-resistant Staphylococcus aureus (MRSA)] strains are present in hospitals, action is necessary to control further spread” (p. 391). We believe, however, that their next sentence, “Aggressive programs in several European countries have documented the success of identifying and treating colonized patients quickly,” (p. 391) misled readers by implying that health care facilities in those countries (and in Western Australia, which has had similar success with a similar approach [2]) quickly treat—but do not isolate—colonized patients, and that treating colonized patients is the key secret to those countries' success in controlling MRSA infection. On the contrary, Dutch eradication therapy is often postponed until conditions are optimal (frequently after discharge), whereas isolation is used for all patients with known or suspected MRSA colonization [3]. A recent Dutch study illustrated the importance of isolation, reporting that MRSA was transmitted to 38 individuals when 3 MRSA-colonized patients were admitted to an intensive care unit (ICU) unsuspected, uncultured, and unisolated, compared with transmission to only 1 individual when 3 other patients were suspected, cultures were performed, and the patients were isolated at admission to the same ICU [4]. Successes at the University of Virginia (Charlottesville) over 26 years, as well as at other American hospitals, confirm the importance of identifying and isolating all colonized patients [5–8], including many situations where eradication therapy was not used [5, 8–10]. Active detection and isolation have worked well for other contagious pathogens, such as smallpox virus [11], severe acute respiratory syndrome (SARS) coronavirus [11], Mycobacterium tuberculosis [12], and other antibiotic-resistant pathogens, such as vancomycin-resistant Enterococcus species, for which eradication therapy was not possible [13–16].

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