oa SA Pharmaceutical Journal - Building the road : a perspective from an infectious diseases clinical pharmacist in the United States : forum
Multidrug resistance in many bacterial species has been on the rise in recent years and the spread is global. We all face the challenge of increasing resistance among Grampositive and Gram-negative organisms, causing infections both in the hospital and in the community and in all ages. We have observed increasing resistance in Staphylococcus aureus to methicillin and vancomycin, and enterococci to vancomycin. We have observed beta-lactamases evolve, and also how new carbapenemases, like Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-beta-lactamase-1 (NDM-1), become more prevalent in Gram-negative bacterial species. These resistance mechanisms are complex, leave prescribers with few treatment options, and may not be detectable in resource-limited settings. It is clear, however, that resistance to the more commonly used antibiotics is occurring, and that this challenges practitioners in all settings. The importance of judicious antimicrobial use (the right selection, duration, dose, and route) to treat infections appropriately and to decrease some of the observed increases in resistance are of utmost importance. It is critical to all disciplines and requires a multidisciplinary effort.
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