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Education And Debate

The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions

BMJ 1998; 317 doi: (Published 05 September 1998) Cite this as: BMJ 1998;317:652
  1. Marc J Struelens, professor of clinical microbiology
  1. Department of Clinical Microbiology, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium


    Hospitals, and particularly intensive care units, are an important breeding ground for the development and spread of antibiotic resistant bacteria. This is the consequence of exposing to heavy antibiotic use a high density patient population in frequent contact with healthcare staff and the attendant risk of cross infection. 1 2 Antibiotic resistance increases the morbidity and mortality associated with infections and contributes substantially to rising costs of care resulting from prolonged hospital stays and the need for more expensive drugs.13 In this review I will outline the current problems caused by major drug resistant nosocomial pathogens, examine factors that promote antibiotic resistance in hospitals, and discuss strategies for control.

    Summary points

    • The increasing incidence of hospital acquired infections caused by antibiotic resistant pathogens has led to an increase in morbidity and mortality

    • Resistance results from the interplay of micro-organisms, patients, and the hospital environment, including antibiotic use and infection control practices

    • An important cause of increasing antibiotic resistance is the selection of resistant bacterial strains by mutation and transfer of mobile resistance genes as a result of excessive antibiotic prescribing by hospital doctors

    • Increasing antibiotic resistance is also caused by transmission of resistant bacteria within hospitals by cross colonisation of patients via the hands of healthcare staff and subsequent spread between hospitals by transfer of colonised patients

    • Strategies to control antibiotic resistance in hospitals include multidisciplinary cooperation in implementing local policies on use of antibiotics and infection control measures, timely detection and reporting of the antibiotic resistant strains, improved surveillance, and aggressive control of transmission of epidemic resistant bacteria

    The rise in antimicrobial resistance

    Among pathogens causing hospital infections, Gram positive cocci have become predominant over the past two decades. This trend is related to these pathogens' capacity for accumulating antibiotic resistance determinants.2 A notable example is that of methicillin resistant strains …

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