Bacteria possess a remarkable number of ways to become resistant to antibiotics. Antibiotic resistance has become a major problem in the treatment of Gram-positive infections. Resistance to methicillin and vancomycin in staphylococci and enterococci has resulted in organisms that are resistant to all known antibiotics. Although it is important to continue to search for newer and more effective antibiotics, it is imperative that we develop a surgical mindset of appropriate antibiotic stewardship. The use of single-dose prophylactic regimens, using narrow-spectrum agents when possible for therapeutic indications, limiting the duration of therapeutic agents appropriately, avoiding the use of vancomycin except when necessary, and adhering to strict infection control measures are all steps that will limit the spread and development of resistant organisms.
Get full access to this article
View all access options for this article.
References
1.
ShlaesDM, GerdingDN, JohnJFJr, . Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: Guidelines for the prevention of antimicrobial resistance in ClinInfect Dis1997;25:584–99.
2.
GoldHS, MoelleringRCJr. Antimicrobial-drug resistance. N Engl J Med1996;335:1445–53.
3.
CohenFL, TartaskyD. Microbial resistance to drug therapy: A review. Am J Infect Control1997;25:51–64.
4.
FileTMJr. Overview of resistance in the 1990s. Chest1999;115(3 Suppl):3S–8S.
5.
NeuHC. Emerging trends in antimicrobial resistance in surgical infections: A review. Eur J Surg Suppl1994;573:7–18.
6.
BargN. New resistance mechanisms of common bacterial pathogens. Contemp Intern Med1995;7:61–69.
7.
ShlaesDM, RiceLB. Emerging mechanisms of B-Lactam resistance: An update. Infect Dis Clin Pract1995;4: S175–S186.
8.
ThornsberryC. Trends in antimicrobial resistance among today's bacterial pathogens. Pharmacotherapy1995;15:3S–8S.
9.
NeuHC. The crisis in antibiotic resistance. Science1992; 257:1064–73.
10.
BushK, JacobyGA, MedeirosAA. A functional classification scheme for β-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother1995;39:1211–33.
11.
LivermoreDM. β-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev1995;8:557–84.
12.
SandersCC, SandersWE. Resistance to antibacterial agents. In: JungkindDL, ed. Antimicrobial Resistance: A Crisis in Health Care. NY: Plenum Press, 1995, pp 15–23.
13.
HayesJD, WolfCR. Molecular mechanisms of drug resistance. Biochem J1990;272:281–95.
14.
ChopraI. Efflux-based antibiotic resistance mechanisms: The evidence for increasing prevalence. J Antimicrob Chemother1992;30:737–9.
15.
ArthurM, CourvalinP. Genetics and mechanisms of glycopeptide resistance in enterococci. Antimicrob Agents Chemother1993;37:1563–71.
16.
NobleWC, ViraniZ, CreeRG. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus.FEMS Microbiol Lett1992;72: 195–8.
17.
JonesRN. Impact of changing pathogens and antimicrobial susceptibility patterns in the treatment of serious infections in hospitalized patients. Am J Med1996;100(6A):3S–12S.
18.
MarananMC, MoreiraB, Boyle-VavraS, DaumRS. Antimicrobial resistance in staphylococci: Epidemiology, molecular mechanisms, and clinical relevance. Infect Dis Clin North Am1997;11:813–49.
19.
PanlilioAL, CulverDH, GaynesRP, . Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975–1991. Infect Control Hosp Epidemiol1992;13:582–6.
20.
SmithTL, PearsonML, WilcoxKR, . Emergence of vancomycin resistance in Staphylococcus aureus: Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med1999;340:493–501.
21.
NicasTI, ZeckelML, BraunDK. Beyond vancomycin: New therapies to meet the challenge of glycopeptide resistance. Trends Microbiol1997;5:240–9.
22.
SchabergDR, CulverDH, GaynesRP. Major trends in the microbial etiology of nosocomial infection. Am J Med1991;91(3B):72S–75S.
23.
FrenchGL. Enterococci and vancomycin resistance. Clin Infect Dis1998;27(Suppl 1):S75–83.
24.
BanerjeeSN, EmoriTG, CulverDH, . Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989. National Nosocomial Infections Surveillance System. Am J Med1991;91(3B):86S—89S.
25.
Beck-SagueC, JarvisWR. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. National Nosocomial Infections Surveillance System. J Infect Dis1993;167:1247–51.
26.
Vanden BosscheH, WillemsensG, MarichalP. Anti-Candida drugs: The biochemical basis for their activity. Crit Rev Microbiol1987;15:57–72.
27.
WhiteTC, MarrKA, BowdenRA. Clinical, cellular, and molecular factors that contribute to antifungal drug resistance. Clin Microbiol Rev1998;11:382–402.
28.
PriceMF, LaRoccoMT, GentryLO. Fluconazole susceptibilities of Candida species and distribution of species recovered from blood cultures over a 5-year period. Antimicrob Agents Chemother1994;38:1422–7.
29.
McGowanJEJr. Antibiotic resistance in hospital bacteria: Current patterns, modes for appearance or spread, and economic impact. Rev Med Microbiol1991;2:161–9.
30.
McGowanJEJr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis1983;5: 1033–48.
