Spread of Antibiotic Resistant Strains in the Home and Community

In addition to assessing the potential risks of spread of infections in home and everyday life settings, there is a further aspect which needs to be considered.  Tackling antibiotic resistance is now a global priority, and there is now increasing awareness that hygiene measures are a central part of reducing spread of drug-resistant organisms. Currently, the focus is on preventing spread of resistant superbugs in hospitals, but it is increasingly recognised that this is just as much a home and community problem.

In the community, otherwise healthy people can become persistent skin carriers of MRSA, or faecal carriers of enterobacteria strains which carry multi-antibiotic resistance factors (e.g NDM-1 or ESBL-producing strains). Because these people are perfectly healthy i.e there is no evidence of clinical disease, the risks are not apparent until they are, for example, admitted to hospital, when they can become “self infected” with their own resistant organisms following a surgical procedure, and then spread it to other patients.

It is thought that the major source of nosocomial pathogens is the patient’s endogenous flora. Sometimes these infections occur in the community. As persistent nasal, skin or bowel carriage in the healthy population spreads “silently” across the world, the risks from drug resistant strains in both hospitals and the community increases. This means that hygiene measures in home and everyday life settings are important in the fight against antibiotic resistance, not just because they reduce the need for antibiotic prescribing (i.e reduce the number of infections requiring antibiotic treatment) they can also reduce the spread of resistant strains in the healthy community, reducing not only the spread of drug resistant infections, but also the rate of carriage in the healthy population. This a review of the increasing amount of published data which examines this topic.