Clinical significance of emergence of bacterial antimicrobial resistance in the hospital environment

... Hospital acquired infection (HAI) comprises a considerable burden to patients and healthcare delivery globally. Antimicrobial resistant organisms pose an increasing threat, although multiple resistant pathogens are still in the minority. Many global networks and initiatives are addressing this threat with variable degrees of success. Antibiotic resistance control has a high profile but the same is not true for biocide resistance. The many issues relating to biocide resistance are examined, the paradigm with antiseptic use are explored and ways in which biocide resistance could threaten the prevention and control of HAIs are described. Several proposals to inform the need and nature of surveillance, prevention and control measures are made. Antimicrobial resistance is a global issue of great importance; the possibility of untreatable infections is ever nigh (Cookson 2000a). In response to this, the World Health Organization has advocated a multi‐disciplinary Global Strategy in an attempt to address the many facets of the problem (Anonymous 2004). The European Union (EU) also considers the threat of antimicrobial resistance to be extremely serious and has established several interactive surveillance networks and research projects. The European Antimicrobial Resistance Surveillance Scheme (EARSS) project (http://www.earss.rivm.nl/; April 2005) has documented the current occurrence of several pathogens where there are known and important antibiotic resistance problems, such as pneumococci and Staphylococcus aureus, including methicillin‐resistant isolates (MRSA). The European Surveillance of Antimicrobial Consumption project (http://www.ua.ac.be/main.aspx?c=ESAC2&n=22186; April 2005) has established a database of antimicrobial usage and will be interacting with EARSS to explore the relationship between antibiotic pressure and resistance to produce important information for the EU (see Bronzwaer et al. 2002). Other projects, such as Antibiotic Resistance Prevention and Control (ARPAC: http://www.abdn.ac.uk/arpac; April 2005) are exploring the relationship between these and infection control resources and strategies. A previous review mentioned the increasing interest at Government level (Hosein et al. 2002) in the United Kingdom, and this is also an important new theme of the WHO Strategy (Anonymous 2004).