Time for biocide stewardship?

To the Editor — We wish to comment on the article by Lee et al.1 recently published in Nature Microbiology. We welcome this important work emphasizing the global spread of pathogenic multidrugresistant Staphylococcus epidermidis, but wish to highlight some critical findings derived from the deposited genomic data, which have been partially reported in the Supplementary Information (Supplementary Table 1, sheet D) but not discussed in the article. The study by Lee et al.1 supports the concerns raised in numerous smallerscale and local studies that S. epidermidis is a dominant reservoir of multidrugresistance genes2. The authors’ main focus is the prevalence of rpoB, associated with resistance to rifampicin — an antibiotic widely used in medical devices. We wish to draw the reader’s attention to the high carriage of biocide resistance genes, as well as heavy-metal resistance in association with staphylococcal cassette chromosome mec (SCCmec) elements in hospital-adapted, multidrug-resistant S. epidermidis.