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Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms
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The human cost of resistance: ethical implications of coping with isolation for multidrug resistant organisms

Sibylle C Mellinghoff1, Alessandra A Grossi2, Claudia Recanatini3

  • 1Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Department I of Internal Medicine, Division of Infectious Diseases and Excellence Centre for Medical Mycology (ECMM), Cologne, Germany; German Center for Infection Research Deutsches Zentrum für Infektionsforschung (DZIF), Partner Site Bonn-Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|June 6, 2026
PubMed
Abstract

Insights

Routine isolation for multidrug-resistant organisms (MDROs) requires re-evaluation. Evidence suggests community spread and adverse effects necessitate a balanced, human-centered approach to infection prevention.

Area of Science:

  • Infectious Diseases
  • Medical Ethics
  • Healthcare Policy

Background:

  • Isolation is a standard strategy to curb multidrug-resistant organism (MDRO) spread in healthcare settings.
  • Growing evidence indicates community transmission of MDROs, questioning routine isolation's necessity and proportionality.
  • Isolation is linked to negative outcomes, including reduced care quality, treatment delays, and psychological distress.

Purpose of the Study:

  • To review clinical evidence and ethical discussions on MDRO isolation practices.
  • To analyze the outcomes, ethical implications, and alternatives to current isolation protocols.
  • To propose an integrated epistemic-ethical framework for decision-making.

Main Methods:

  • Narrative review of current clinical evidence.
  • Synthesis of ethical debates surrounding MDRO isolation.
  • Examination of empirical data and normative analysis.

Main Results:

  • Routine isolation practices for MDROs present ethical tensions between safety and patient autonomy.
  • The effectiveness and proportionality of isolation are questioned due to community spread and adverse effects.
  • An integrative perspective combining empirical data and ethical analysis is proposed.

Conclusions:

  • Decision-making for MDRO isolation must be transparent, proportionate, and evidence-based.
  • Interdisciplinary dialogue is crucial for developing balanced infection prevention strategies.
  • A human-centered approach is needed to mitigate harm, ensure safety, and promote compassionate healthcare.
Keywords:
Ethical debateIsolationMultidrug resistancePatient autonomyPatient-centred medicine

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