Infection Prevention and Control Strategies According to the Type of Multidrug-Resistant Bacteria and Candida auris in Intensive Care Units: A Pragmatic Resume including Pathogens R0 and a Cost-Effectiveness Analysis

Multidrug-resistant organism (MDRO) outbreaks have been steadily increasing in intensive
care units (ICUs). Still, healthcare institutions and workers (HCWs) have not reached unanimity on
how and when to implement infection prevention and control (IPC) strategies. We aimed to provide
a pragmatic physician practice-oriented resume of strategies towards different MDRO outbreaks
in ICUs. We performed a narrative review on IPC in ICUs, investigating patient-to-staff ratios;
education, isolation, decolonization, screening, and hygiene practices; outbreak reporting; costeffectiveness;
reproduction numbers (R0); and future perspectives. The most effective IPC strategy
remains unknown. Most studies focus on a specific pathogen or disease, making the clinician lose
sight of the big picture. IPC strategies have proven their cost-effectiveness regardless of typology,
country, and pathogen. A standardized, universal, pragmatic protocol for HCW education should
be elaborated. Likewise, the elaboration of a rapid outbreak recognition tool (i.e., an easy-to-use
mathematical model) would improve early diagnosis and prevent spreading. Further studies are
needed to express views in favor or against MDRO decolonization. New promising strategies are
emerging and need to be tested in the field. The lack of IPC strategy application has made and
still makes ICUs major MDRO reservoirs in the community. In a not-too-distant future, genetic
engineering and phage therapies could represent a plot twist in MDRO IPC strategies.