Surveillance and Stewardship: Where Infection Prevention and Antimicrobial Stewardship Intersect

Abstract

Colonization with multidrug-resistant organisms (MDRO) is a risk factor for subsequent infection. Surveillance for MDROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase-(ESBL) producing Enterobacterales, and carbapenemase-producing organisms (CPO), is commonly conducted in hospitals to prevent spread of MDROs, in part to reduce the potential for additional infections. Although colonization is a risk factor for infection, data on colonization with various MDROs are often not considered when selecting anti-infective therapy. There are conflicting data on the strength of the positive and negative predictive values of the colonization test results to guide therapeutic strategies. Defining therapeutic strategies for patients with complicated or drug-resistant infections or to select antimicrobial prophylaxis prior to performing prostate biopsies often falls under the purview of the antimicrobial stewardship team. Should colonization data, which is often present in the patient’s medical record from routine infection prevention measures, be reviewed before selecting therapy for infections or for prophylaxis? This perspective will explore the intersection of infection control and antimicrobial stewardship activities.