When antibiotics were introduced in...

When antibiotics were introduced in the medical arena in the 1940 many believed they were the definitive answer to infectious disease. Within a not many years, however, microbes had begun to exhibit their resistance to antibiotics. At united time, Walt Kelly's comic strip character, Pogo described pollution, saying, "We have met the enemy and he is us." Today, however, he could have been describing the alarming medical threat of bacterial infections that are resistant to all known antibiotics.

each year, 17 million people die of infectious diseases. Emerging highly infectious viral agents, resurgent diseases, and mutating bacteria have combined to create a global health care crisis.(1) Despite major strides in prevention and sway infectious diseases continue to take a significant and economic toll forward society. The cost to the health care arrangement is enormous. One report estimated the annual costliness of antibiotic resistance to a single pathogen, Staphylococcus aureus, was $122 million.(2) In 1995 the annual splendor was estimated to be at least $15 billion.(3) Organisms that one time displayed uniform susceptibility now exhibit resistance to specific antibiotics.

The enigma has created a serious matter for patients with prolonged hospital stays. Since the 1980 the number of reported nosocomial infections, particularly bacterial infections, has increased drastically. The US Center for Disease ascendency and Prevention (CDC) estimates that the annual charge of treating patients who acquire nosocomial infections in acute care facilities in the United States is $35 billion.(4) The incidence of nosocomial gram-positive infections has continued to rise, and available antimicrobials have become useless against resistant strains (Figure 1) Coagulase-negative staphylococci (CNS) s aureus, and enterococci now are the three mostly common nosocomial isolates, comprising 67% of all nosocomial bacteremias.(5) For the preponderance of CN and s aureus strains, vancomycin remains the appropriate therapeutic option, it now has been documented, however, that 17% of all enterococci isolates are vancomycin resistant.

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A SIGNIFICANT PROBLEM

A national surveillance scheme involving several hundred tertiary care medical center between 1980 and 1989 revealed a 754% increase in CN children infections.(6) This project also revealed a 120% increase in enterococcal infections and a 176% increase in s aureus infections. A more latter survey examined nosocomial bacteremic infections in more than 4500 patients between 1995 and 1996 and found

* 67% of infections were caused by way of gram-positive bacteria,

* 79% of infections were methicillin-resistant CNS

* 28% were methicillin-resistant s aureus (MRSA), and

* 17% were vancomycin-resistant enterococci (VRE)

In cases in which pathogens were susceptible to multiple medications, pathogens rapidly were becoming susceptible to vancomycin simply or completely nonsusceptible.(7)

NOSOCOMIAL INFECTIONS

Antibiotic resistance can be institute in all organisms, including bacteria, fungi, viruses, and parasites. Among these, bacteria are the greatest bear upon because of their prevalence in the two hospital and community settings. Bacterial resistance to antibiotics can ensue in patients having

* increased severity of illnesses,

* more debilitating diseases,

* longer hospital stays,

* adverse long-term sequelae, and

* higher mortality rates.

Collectively, these factors create great richnesss for the health care system

Losing mould According to the CDC, each year approximately pair million people acquire infections while being hospitalized.(8) Microbes that have evolveed antibiotic or multimedication resistance typically are the primary cause for infections and complicate treatment. Although resistance is possible in all microbes (ie, bacteria, fungi, viruses), bacteria cause the majority of medication-resistant puzzles It currently is estimated that 70% of bacteria causing these infections are resistant to at least single of the more commonly used antibiotics.(9) More alarming is that 60% of patient deaths that are attributed to infections are caused from bacteria that now are resistant to at least united antibiotic.(10)

Data scrape togethered in 1999 show antibiotics losing region to certain pathogens. This application of mind of selected antimicrobial-resistant pathogens associated with nosocomial infections in patients in intensive care units revealed an increased resistance in VRE (43%) MRSA (37%) imipenem-resistant Pseudomonas aeruginosa (56%) and quinolone-resistant P aeruginosa (50%) as compared to data garner uped between 1994 and 1998.(11) This resistance is driving health care workers to use experimental and potentially toxic medications to combat infection.

Impact of contemporary medicine. Patients' shortened hospital stays and the stretch toward outpatient treatment and surgery have contributed to bacterial resistance. It was estimated that 75% of all surgical acts will be performed in ambulatory, same-day, or outpatient ORs by dint of the turn of this century(12) As a arise it is critical that health care professionals make no distinction involving infection hinder and sterile technique between surgical care delivered in conventional inpatient arenas and in outpatient facilities.