Although adequate, some elaboration on the extent of the VRE and MRSA individual infections world-wide in Introduction and discussion would have achieved a better impact in the minds of the reader. Such an elaboration becomes essential taking into consideration that these kinds of publications are read not only by clinicians but also by researchers worldwide working in non-medical areas, as well.
In the aims of the study, patient-to-patient transmission, one of the major routes of nosocomial infections, was not included. This becomes vital taking into observation that some of the patients included in the study were transferred from another hospital to University of Maryland Medical Center (UMMC) [see table 1] and from UMMC to other hospitals and elsewhere. Without including this particular parameter, the authors suggest limiting of patient-to-patient transmission as a remedial measure.
In the laboratory methods, a reference to the mentioned method of culturing is missing. If the method adopted is novel, the same should have been mentioned at appropriate places. Additionally, they do not indicate how Vancomycin resistant Staphylococcus aureus (VRSA) and Vancomycin intermediate Staphylococcus aureus (VISA) were identified. If not included in the present study the same should be mentioned, as the way introduction and discussion were presented, the reader gets a false impression that the researchers were also looking for VRSA and VISA.
Statistical analysis might not be accurate or might be biased as the subsequent positive clinical cultures do not tally with the original clinical cultures [initial cultures were from anterior nares and peri-rectal cultures while the subsequent positives were from blood, Cerebrospinal fluid (CSF) or urine]. Reason for this was not properly explained. Hence although this study addresses one major problem worldwide, the findings and recommendations need more credence.
Whereas it has been clearly mentioned in the article and in table 1 that certain numbers of patients were from other hospitals, what requires clarification is that whether those patients acquired the infection in the first hospital or at UMMC. If this has not been established by the authors, the same should have been mentioned. Presentation of more details with regard to such patients becomes essential in these kinds of studies. Needless to say, the authors make no attempt to elucidate the impact of previous infections in co-colonized patients given the observation (see table 1) that more than 75% of the co-colonized patients were previously infected with either MRSA or VRE. In this scenario, the authors try to speculate that prior infection with VRE, MRSA or both might have contributed to the decision of the patients being admitted to MICU, and might have also had previous admissions and exposures
A significant proportion of the patients were put on Vancomycin prior to culture. The authors need to clarify whether this had any significant influence on the quality of results generated with specific reference to the bacterial cultures, in the present st