Approaches to limiting emergence of antimicrobial resistance in bacteria in human populations.

Infectious diseases continue to be major threats to human health around the world. Within the past few years, several divergent groups of organisms have emerged as significant causes of morbidity and mortality. Included among these are bacteria that are refractory to therapy because of the development of resistance to multiple antimicrobial agents. Multidrug resistance in strains of Mycobacterium tuberculosis, Streptococcus pneumoniae, Shigella dysenteriae, Salmonella typhi, and Enterococcus faecium has been reported. Surveillance of resistant microorganisms in the United States and abroad is fragmentary and targets relatively few organisms. Surveillance is further hampered by the fact that detection of some novel resistance mechanisms is difficult by means of current laboratory methods. Both clinicians and public health officials are likely to continue to face a variety of challenges regarding surveillance, treatment, prevention, and control of drug-resistant infections.