Journal Article

Hospital-Based Strategies for Combating Resistance

Robert C. Owens and Louis Rice

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue Supplement_4, pages S173-S181
Published in print April 2006 | ISSN: 1058-4838
Published online April 2006 | e-ISSN: 1537-6591 | DOI:
Hospital-Based Strategies for Combating Resistance

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Selective pressures generated by the indiscriminate use of β-lactam antibiotics have resulted in increased bacterial resistance across all β-lactams classes. In particular, the use of third-generation cephalosporins has been associated with the emergence of extended-spectrum β-lactamase—producing and AmpC β-lactamase—producing Enterobacteriaceae and vancomycin-resistant enterococci. Conversely, β-lactams (e.g., cefepime, piperacillin-tazobactam, and ampicillin-sulbactam) have not demonstrated such strong selective pressures. Chief among institutional strategies to control outbreaks of multidrug-resistant bacteria are infection-control measures and interventional programs designed to minimize the use of antimicrobial agents that are associated with strong relationships between use and resistance. Successful programs include antimicrobial stewardship programs (prospective audit and feedback), formulary interventions (therapeutic substitutions), formulary restrictions, and vigilant infection control. Fourth-generation cephalosporins, such as cefepime, have proven to be useful substitutes for third-generation cephalosporins, as a part of an overall strategy to minimize the selection and impact of antimicrobial-resistant organisms in hospital settings.

Journal Article.  6897 words. 

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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