“Sustained reductions in the incidence of multidrug-resistant organisms: A 24-year experience”

Seventy years have elapsed since Maxwell Finland published articles describing bacterial resistance to antimicrobial agents at the Boston City Hospital. 1 Since then, the evolution and dissemination of resistance has emerged as a global "crisis" and "calamity." 2,3However, the distinction between the genetics conferring resistance and their incidence rates may be blurred.Simply put, the recognition of a new mechanism of resistance does not tell us about the burden of that organism.Longitudinal surveillance data can provide long-term trends in the incidence of these multidrug-resistant organisms (MDROs) and help to assess whether local control strategies are effective and sustainable.For example, despite the fear of a post-antibiotic era, when incidence rates for 6 MDROs in a large cohort in the United States were calculated over a 6-year span, trends were decreasing for 4 of them. 4The accompanying editorial found "recent evidence of progress" and "some success." 5 Twenty-four years ago, we designed a prospective surveillance system to describe the incidence rates of 6 MDROs among hospitalized adults in our medical center.We have continued to collect data with the same methodology and the same personnel.This method yields prospective, monthly data which can be used to assess the efficacy of our infection prevention, diagnostic stewardship, and antimicrobial stewardship programs.This work extends our findings and presents 24 years of data.We hypothesize that such data are necessary to fully describe the epidemiology of MDROs and assess the success or failure of control strategies.