Comment 8 www.thelancetinfection.com Vol 11 January 2011 Sourasky Medical Center, Tel Aviv, Israel (YC), Department of Medical Sciences, Section for Infectious Diseases, Uppsala University, Uppsala, Sweden (OC); and Department of Internal Medicine, University of Geneva Hospitals; Medical School, Geneva, Switzerland (SH) antoine.andremont@bch.aphp.fr The investigators are indebted to Rosemary Sudan for her editorial assistance. AA and SH have received consultancy fees from Da Volterra. All other authors declare that they have no conflicts of interest. 1 Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009; 9: 228–36. 2 Elemam A, Rahimian J, Mandell W. Infection with panresistant Klebsiella pneumoniae: a report of 2 cases and a brief review of the literature. Clin Infect Dis 2009; 49: 271–74. 3 Carmeli Y, Akova M, Cornaglia G, et al. Controlling the spread of carbapenemase-producing Gram-negatives: therapeutic approach and infection control. Clin Microbiol Infect 2010; 16: 102–11. 4 Chmelnitsky I, Navon-Venezia S, Strahilevitz J, Carmeli Y. Plasmid-mediated qnrB2 and carbapenemase gene bla (KPC-2) carried on the same plasmid in carbapenem-resistant ciprofloxacin-susceptible Enterobacter cloacae isolates. Antimicrob Agents Chemother 2008; 52: 2962–65. 5 Orientation paper: proposed priorities for health research 2011. 2010. ftp://ftp.cordis.europa.eu/pub/fp7/health/docs/healthres2011- orientation_en.pdf (accessed Aug 18, 2010). Surveillance, characterisation, and preservation of multidrug-resistant bacteria Since the US military entered Afghanistan and Iraq, the military health systems in these countries have experienced a marked increase in nosocomial wound and health-care-associated infections caused by Gram-negative multidrug-resistant (MDR) organisms with very limited treatment options. In addition to complicating the care of service members who are wounded, these organisms have spread to, and killed, civilian health-care beneficiaries who are co-located in at least one of the major referral centres that receives patients who are wounded. Similar outbreaks in British and Canadian service members, 1,2 and occupational transmission of Acinetobacter baumannii from a patient who is wounded to a health-care worker resulting in a prolonged, near-fatal infection have also been reported. 3 These MDR organisms often invoke a panoply of mechanisms against the same antibiotic, or use a single mechanism to neutralise several antibiotics, especially in the presence of antibiotic selection pressure. 4 The dry pipeline of research and development for new antibiotic compounds further exacerbates this crisis. 5 Centralised collection, comprehensive characterisation, and long-term storage of MDR organisms is essential for these challenges to be understood and to inform future approaches. Therefore, the Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, USA, launched the MDR Organism Repository and Surveillance Network (MRSN). Under a mandate of performance improvement, US Army hospitals—including those in Iraq and Afghanistan—submit MDR organisms that have been isolated from clinical infections and active surveillance programmes along with associated clinical–demographic information. Isolates undergo integrated phenotypic, clonal, and phylogenetic analyses, including high resolution, whole-genome ordered restriction optical mapping, followed by archival cryopreservation. Repository personnel provide epidemiological reports and information about infection control to hospitals and policy makers, undertake site assistance visits, and submit site-specific and worldwide antibiograms on a secure website. Other US military services are encouraged, but not required, to participate. Synergy can be achieved through interagency collaboration and information sharing 6 Council of the European Union. Council conclusions on innovative incentives for effective antibiotics. Dec 1, 2009. http://www.se2009.eu/ polopoly_fs/1.26034!menu/standard/file/CC%20effective%20antibiotics. pdf (accessed Aug 18, 2010). 7 The European Agency for the Evaluation of Medicinal Products. EMEA discussion paper on anmicrobial resistance. March 25, 1999. http://www.ema.europa.eu/pdfs/human/antimicrobial_ resistance/988099en.pdf (accessed Aug 18, 2010). 8 European Centre for Disease Prevention and Control/EMEA. The bacterial challenge: time to react. 2009. http://www.ema.europa.eu/pdfs/human/ antimicrobial_resistance/EMEA-576176-2009.pdf (accessed Aug 18, 2010). 9 European Medicines Agency. Guideline on the evaluation of medicinal products indicated for treatment of bacterial infections. 2010. http://www.ema.europa.eu/pdfs/human/ewp/055895endraftrev2.pdf (accessed Aug 18, 2010). 10 Kluytmans J, Harbarth S. Methicillin-resistant Staphylococcus aureus decolonization: “yes, we can,” but will it help? Infect Control Hosp Epidemiol 2009; 30: 633–35. 11 Silvestri L, van Saene HK, Milanese M, Gregori D, Gullo A. Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials. J Hosp Infect 2007; 65: 187–203. 12 Brun-Buisson C, Legrand P, Rauss A, et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med 1989; 110: 873–81. 13 Hedlund JU, Ortqvist AB, Kalin ME, Granath F. Factors of importance for the long term prognosis after hospital treated pneumonia. Thorax 1993; 48: 785–89.