Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

Abstract

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention's effectiveness, burdens and costs will be more or less justified, which is especially important for large scale populationlevel interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.

Benefits of patient risk stratification and targeted interventions on multidrug resistant pathogens prevention and control

“…The same logic stands behind surveillance and screening, as thorough sampling is reckoned inappropriate and not feasible. As universal MDR screening in unjustified because of costs and individual burdens, specific screening on targeted population has been advocated [28]. We hold this to be true also for preventive measures.…”

The antimicrobial resistance travel tool, an interactive evidence-based educational tool to limit antimicrobial resistance spread

“…The majority of the included guidance documents recommend to screen all returned travellers who had a hospital admission whilst abroad, irrespective of the country visited or the length of time spent abroad. Evidence suggests that universal screening of returned travellers with a prior hospitalization may not be the most cost-effective 66 and feasible approach.…”

Justifying the More Restrictive Alternative: Ethical Justifications for One Health AMR Policies Rely on Empirical Evidence

“…This applies equally to public health emergencies like pandemics, and urgent but longer-term concerns like AMR. 8 Indeed, effectiveness has already been acknowledged in previous work as a key aspect of justifying certain AMR management interventions (Nijsingh et al, 2020). 9 That is, in most cases, where resistance does not emerge in a particular host who goes on to spread it and cause significant bad outcomes only through their own overuse of antimicrobials and spreading behaviours, a scenario which seems very unlikely.…”