Recent investigations reported in the Journal of Global Antimicrobial Resistance have shed light on the disparities in antibiotic exposures and the associated risks for methicillin-resistant Staphylococcus aureus (MRSA) contamination across different healthcare settings. This exploration zeroes in on the dissimilarities observed between acute care hospitals and affiliated intermediate- and long-term care facilities in the management of MRSA, underscoring the urgency for tailored antibiotic stewardship programs.

DOI: 10.1016/j.jgar.2023.12.025

In a study that bears considerable implications for antibiotic stewardship and infection control, researchers Wei Zhang and colleagues have discerned significant differences in antibiotic exposure risks for MRSA between patients in acute care hospitals and residents in closely-affiliated intermediate- and long-term care facilities. The findings of the study, which were published on January 11, 2024, in the Journal of Global Antimicrobial Resistance with the DOI 10.1016/j.jgar.2023.12.025, paves the way for a more nuanced approach to combating antibiotic resistance across diverse healthcare settings.

MRSA, a type of bacteria resistant to many antibiotics, remains a formidable challenge in healthcare settings worldwide. Its prevalence in hospitals and long-term care facilities poses a grave threat to patient and resident safety, necessitating vigilant monitoring and intervention strategies.

The study conducted by Zhang and associates involved meticulous data collection and analysis from an acute care hospital and its affiliated intermediate- and long-term care facilities, revealing a higher incidence of antibiotic exposure in the long-term care environment. This disparity may be attributed to several factors, including varying patient demographics, the complexity of medical conditions, duration of stays, and institutional policies regarding antibiotic use.

While acute care hospitals typically treat a wide range of patients, including those with urgent and complex medical needs, intermediate- and long-term care facilities cater more to individuals requiring extended rehabilitation or chronic care management. As such, the contexts in which antibiotics are administered diverge significantly, influencing the exposure risks for MRSA colonization or infection.

Importantly, the findings underscore the necessity of adopting distinct antibiotic stewardship strategies tailored to the specific context of each healthcare setting. In acute care hospitals, the emphasis might be on rapid diagnostics and targeted therapy, considering the short duration of patient stays and the acuity of illnesses. In contrast, intermediate- and long-term care facilities might benefit from a more conservative antibiotic approach, given the protracted exposure of residents to the healthcare environment and the potential for cumulative risk over time.

The research was spearheaded by Wei Zhang from the Infection Prevention and Control Office at Woodlands Health, Singapore, who collaborated with Kala Kanagasabai from Ren Ci Hospital, Jocelyn Koh from Ang Mo Kio-Thye Hua Kwan Hospital, Brenda Ang from several healthcare and academic institutions in Singapore, and Angela Chow from Tan Tock Seng Hospital and the National University of Singapore. Their combined expertise spanning clinical healthcare, epidemiology, and public health offers a robust foundation for the conclusions drawn from their research.

Addressing antibiotic resistance requires a concerted effort among healthcare professionals to embrace stewardship initiatives that acknowledge the distinct needs and risk profiles of different patient populations. The implementation of such measures is critical in curbing the spread of drug-resistant organisms like MRSA and ensuring that antibiotics retain their efficacy for future generations.

The study calls for an integrated approach that encompasses education, policy revisions, and enhanced infection prevention measures tailored to the nuances of each healthcare context. By acknowledging the variance in antibiotic exposure risks, healthcare administrators can better allocate resources and support for targeted interventions aimed at minimizing MRSA transmission.

This research also advocates for ongoing surveillance and data collection efforts to foster a dynamic understanding of MRSA risks and the effectiveness of implemented stewardship practices. Data-driven insights will remain an invaluable asset in the evolving landscape of antibiotic resistance management.

In conclusion, the study by Zhang and colleagues advances our understanding of healthcare-associated MRSA risks and serves as a foundation for developing more effective antibiotic stewardship programs. It emphasizes that a ‘one-size-fits-all’ approach to antibiotic management could be suboptimal, potentially leading to increased resistance and negative patient outcomes. The research champions the need for setting-specific strategies that not only protect patients and residents but also preserve the integrity of antibiotic treatments for future use.


1. Zhang W, Kanagasabai K, Koh J, Ang B, Chow A. Differences in antibiotic exposures and antibiotic exposure risks for methicillin-resistant Staphylococcus aureus between patients in an acute care hospital and residents in its closely-affiliated intermediate- and long-term care facilities. J Glob Antimicrob Resist. 2024 Jan 11. DOI: 10.1016/j.jgar.2023.12.025

2. Antibiotic Stewardship Programs in Health Care Settings: Core Elements. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/core-elements/index.html

3. WHO Guidelines on Hand Hygiene in Health Care. World Health Organization. https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf

4. Antibiotic Resistance Threats in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf

5. Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals. Infect Control Hosp Epidemiol. https://doi.org/10.1086/676533


1. Antibiotic Stewardship Strategies
2. MRSA Exposure Risks
3. Health Care-Associated Infections
4. Antibiotic Resistance Management
5. Infection Prevention in Long Term Care