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

Journal article
Authors Niels Nijsingh
Christian Munthe
Anna Lindblom
Christina Åhrén
Published in Monash Bioethics Review
ISSN 1321-2753
Publication year 2020
Published at Institute of Biomedicine, Department of Microbiology and Immunology
Department of Philosophy, Linguistics and Theory of Science
Centre for antibiotic resistance research, CARe
Institute of Biomedicine, Department of Infectious Medicine
Language en
Keywords Antibiotic resistance, Antimicrobial resistance, Antibiotic stewardship, Antimicrobial stewardship, AMR, ABR, sanitation, hygiene, health policy, bioethics, ethics, healthcare ethics, surveillance
Subject categories Practical philosophy, Ethics, Public Health, Global Health, Social Medicine and Epidemiology, Medical Ethics, Infectious Medicine, Health Care Service and Management, Health Policy and Services and Health Economy, Public health science, Public health medicine research areas, Epidemiology, Community medicine


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 population-level 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.

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