Decolonization, containment or source control? Pathogen-specific anti-infective prevention for methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CRE) and Candida auris.

INTRODUCTION: Healthcare systems use decolonization, screening, patient placement, environmental cleaning and stewardship to prevent Methicillin-Resistant Staphylococcus aureus (MRSA), Carbapenem-Resistant Enterobacterales (CRE) and Candida auris transmission and infection. These interventions share an Infection Prevention and Control (IPC) foundation but differ in evidence, operational demands and the reservoirs they target.

AREAS COVERED: This critical narrative review compares pathogen-targeted and universal (horizontal) strategies, including topical decolonization, antiseptic bathing, surveillance-linked containment, environmental/source control and antimicrobial stewardship. It examines study design, endpoint directness, diagnostic intensity, implementation fidelity, feasibility and local resource constraints.

EXPERT OPINION: The three pathogen pathways are analytical emphases rather than mutually exclusive models. MRSA has the most developed trial evidence for topical decolonization in selected settings, although chlorhexidine effects may also be horizontal. CRE and C. auris prevention generally requires universal IPC measures combined with targeted screening, placement, environmental control or emerging adjunctive decolonization according to local epidemiology and capacity.