Antibiotic-Resistant Bacteria and Healthcare Systems: Four Steps for Effective Response

That bacteria resistant to multiple antibiotics pose an increasing threat to our health is no longer news. The arrival of this problem now has been addressed extensively by the medical community.)-3 Moreover, problems associated with multiple-drugresistant (MDR) bacteria have been detailed for the public in newspapers, newsmagazines, on television, and in other popular media. Books also have been written for the public, informing them of the difficulties that MDR organisms pose and the importance of appropriate antibiotic use.4 What should be today's news, then, is the responses that are being made to deal with MDR organisms by the medical community, the public, and the government. Unfortunately, however, these responses have been slow and relatively uncoordinated. While governmental agencies, healthcare organizations, and professional societies try to figure out how best to deal with these new MDR organisms, public and healthcare worker concern grows. Nowhere is the problem of drug resistance more pertinent than in the acute care hospital. True, the increase in pneumococci with resistance to penicillin has a major impact on the community, and methicillinresistant Staphylococcus aureus (MRSA) now have become common in extended care facilities and a few communities as well as in hospitals. However, other prominent MDR organisms primarily have been hospital-based to date. Vancomycin-resistant enterococci (VRE) have been reported primarily as nosocomial pathogens, whether in outbreaks or in endemic patterns of occurrence. Klebsiella pneumoniae, Escherichia c li, and other Enterobacteriaceae that produce extended-sp ctrum p-lactamases usually have exploited the hospital setting as well. Formerly rare gram-negative bacilli like Acinetobacter species have discovered ways to resist all except a few antimicrobials; concurrently they have become the most frequent organism causing infection in intensive care unit patients in many U.S. hospitals.5 Thus, defining appropriate control measures for MDR organisms is a particular concern for acute care hospitals.