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To the Editor: Although we share the concerns of Dr Stelfox and colleagues¹ about the negative outcomes of isolation, these must be weighed against the risks of infection with and transmission of resistant organisms. The authors' study design may have led to overestimation of the adverse effects of isolation.

Although patients who were colonized with MRSA were similar to uncolonized control patients with respect to most baseline factors, the authors did not control for previous hospitalization. Prior hospitalization and contact with the health care system are risk factors for MRSA colonization and infection.² Previous hospitalization is also related to several of the outcomes measured in the study, such as pressure ulcers and falls, and may influence the diagnostic workup performed during subsequent admissions. For example, a patient with congestive heart failure is unlikely to undergo assessment of ventricular function if the same study had been performed during a recent hospitalization. . . . [Full Text of this Article]

Stephen G. Weber, MD, MS
Section of Infectious Diseases
University of Chicago Hospitals
Chicago, Ill

Trish M. Perl, MD, MSc; Sara E. Cosgrove, MD, MS
Division of Infectious Diseases
Johns Hopkins Medical Institutions
Baltimore, Md

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