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Decolonization, containment or source control? Pathogen-specific anti-infective prevention for methicillin-resistant

Abdelaziz Touati1

  • 1FSNV, laboratoire d'Ecologie Microbienne, Université de Bejaia, Bejaia, Algeria.

Expert Review of Anti-Infective Therapy
|August 11, 2026
PubMed
Abstract

Insights

Healthcare systems use infection prevention and control (IPC) strategies to combat resistant pathogens like Methicillin-Resistant Staphylococcus aureus (MRSA), Carbapenem-Resistant Enterobacterales (CRE), and Candida auris. This review compares targeted versus universal IPC approaches.

Area of Science:

  • Infectious Diseases
  • Healthcare Epidemiology
  • Antimicrobial Resistance

Background:

  • Healthcare systems employ various strategies to prevent transmission of multidrug-resistant organisms (MDROs).
  • Key interventions include decolonization, screening, patient placement, environmental cleaning, and antimicrobial stewardship.
  • These Infection Prevention and Control (IPC) measures target specific pathogens like Methicillin-Resistant Staphylococcus aureus (MRSA), Carbapenem-Resistant Enterobacterales (CRE), and Candida auris.

Purpose of the Study:

  • To critically review and compare pathogen-targeted versus universal IPC strategies for preventing MDRO transmission.
  • To examine the evidence base, operational demands, and target reservoirs of different IPC interventions.
  • To assess factors influencing the feasibility and effectiveness of these strategies.

Main Methods:

  • A critical narrative review approach was utilized.
  • Comparison of pathogen-targeted and universal IPC strategies, including decolonization, bathing, screening, environmental control, and stewardship.
  • Evaluation of study design, endpoint directness, diagnostic intensity, implementation fidelity, feasibility, and resource constraints.

Main Results:

  • Methicillin-Resistant Staphylococcus aureus (MRSA) has the most robust trial evidence for topical decolonization in specific settings.
  • Chlorhexidine may exhibit broader, horizontal effects beyond targeted decolonization.
  • Prevention of Carbapenem-Resistant Enterobacterales (CRE) and Candida auris typically necessitates universal IPC measures coupled with targeted interventions based on local context.

Conclusions:

  • Pathogen-specific prevention strategies are not mutually exclusive and often complement universal IPC measures.
  • The choice and implementation of IPC interventions for CRE and C. auris depend on local epidemiology and healthcare capacity.
  • Optimizing IPC requires a nuanced approach, integrating targeted and universal strategies effectively.
Keywords:
Antiseptic bathingCandida aurisStaphylococcus aureuscarbapenem-resistant enterobacteralesdecolonizationinfection preventionsource controlsurveillance

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