Microbial resistance presents a significant challenge to clinicians in all settings. Bacteria mutate spontaneously, and because of their rapid replication rates (½ hour for S. Aureus division), there can be hundreds of mutations in one day in one bacterial population. Generally, it takes more than one mutation in a bacterium to induce drug resistance. In the presence of antibiotics, resistant bacteria are selected and reproduce without competition from sensitive bacteria. Inappropriate use of antibiotics can lead to more relentless patterns of resistance. Stopping antibiotics too early in the course, giving sub-lethal doses (for the bacterial strain), prescribing antibiotics inappropriately, and other practices that do not meet standards of practice, lead to overgrowth of resistant and pathologic strains. In addition, bacteria can pass resistance genes to other microbes via genetic sequences and create more resistant organisms within the same host.
Compounding the problem is the fact that resistant strain generation can far outpace the development of new antibiotics to combat them. Currently, there are only a handful of large pharmaceutical companies that have new antimicrobials in laboratory and clinical trials. Of these drugs, only about 10 % show promise of mechanisms to defeat multidrug-resistant organisms. In addition, the financial returns on antimicrobials cannot compare to those of drugs prescribed for chronic conditions. Antibiotic use is episodic, and therefore, there is less impetus to develop pharmaceuticals that do not yield the larger returns on investment for research and development.
Fighting Back: What Is Being Done?
Prevention: Hygienic practices regarding hand washing and use of disinfectants promulgated by public health agencies have generalized from the public to best practices in health care settings. Adoption of sterile technique is now mandated for all invasive procedures, even at the bedside. A government initiative is in place to educate primary care physicians in proper prescribing of antibiotics, to avoid inappropriate use, especially in respiratory infections, which are the setting of respiratory infections, which are predominantly viral. This same strategy applies to the education of the public, to increase awareness about antibiotic resistance and proper use of these drugs.
Antibiotic Stewardship: This is a national initiative to assemble teams in each medical institution consisting of physicians, pharmacists, infection preventionists, hospital epidemiologists, nurses, lab staff and IT staff. In this way, standards can be established for best practices regarding culturing, treatment and collection of data for infections.