Implementation of strategies to control antimicrobial resistance.

Antimicrobial resistance has emerged as a major public health issue in recent years. A steady increase in resistance continues despite the introduction of new antibiotics, and resistant bacteria have been associated with increased patient morbidity and mortality as well as with increased costs. Addressing the problem of antimicrobial resistance requires both infection control and regulation of antibiotic use; addressing either alone is insufficient. Mounting evidence shows that control of the use of broad-spectrum antibiotics (especially vancomycin and third-generation cephalosporins) and implementation of infection control measures can result in decreased incidence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella. Recent reports from professional organizations and a consensus of experts have outlined strategies for the control of resistance in hospitals, with specific measures identified for antibiotic control and infection control. These reports have emphasized the importance of a multidisciplinary approach in tackling this problem in hospitals and have suggested that a quality-improvement model be used to address antimicrobial resistance. A close collaboration among the disciplines of infectious diseases, microbiology, hospital epidemiology, pharmacy, and nursing, with particular emphasis in ICUs, and with strong support from hospital leadership, can result in an effective program that can be readily incorporated into the quality-improvement goals of any health-care organization.