Update on the antibacterial resistance crisis.

This nation--and in fact the world--is currently facing a crisis in the form of a growing antibacterial drug resistance. In the 60 or so years since the discovery of penicillin, physicians and pharmaceutical companies have been constantly challenged to stay a step ahead of the bacteria that constantly adapt to the drugs used to control them. These magic bullets were at one time expected to eliminate the concern over infectious disease and have been relied upon heavily. But their effectiveness has been steadily waning in recent years as, more and more, strains of bacteria emerge that are resistant to multiple drugs and, in some cases, have become nearly "panresistant." Nosocomial infections with these resistant strains were once confined to hospitals but new community-acquired infections are an ominous portent. Meanwhile, perhaps equally as distressing, many pharmaceutical companies are discontinuing efforts to develop new antimicrobial drugs for a variety of reasons and few new agents are currently in the pipeline. The selective pressure triggering these bacterial mutations are complex, but they can be shared by healthcare workers, hospitals, long-term care facilities, the agriculture industry, and even healthcare consumers themselves. In this paper, these topics are discussed, in turn, and the paper concludes with an apologia for change that can and should be equally shared by these stakeholders.