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Background
The emergence of antimicrobial resistance is a complex problem driven by many interconnected factors. Over the past few decades, several concurrent trends have accelerated the development and spread of resistant microbes. These include urbanization, pollution, environmental degradation, changing weather patterns, and a growing proportion of elderly people needing hospital-based treatments. However, according to the WHO, the main causes of antimicrobial resistance are under use of antibiotics in developing countries and overuse, including inappropriate and unnecessary use, of antibiotics in industrialized countries. An antimicrobial agent used for any infection, in any dose, and over any time period causes selective pressure on microbial populations, leading to the development of resistant mutants. Once a microbe demonstrates reduced susceptibility, it has the potential to become fully resistant.
Increased incidence of infections has contributed to a greater selective pressure favoring resistant microorganisms, resulting in the spread of resistance genes and resistant bacteria.
While many factors have been identified that are responsible for driving bacterial resistance, most experts agree that antibiotic use is a major contributor to both hospital and community resistance. Inappropriate antibiotic use includes: using an antibiotic when none is needed; using the wrong duration of therapy (too long or too short); using an inappropriate dose; using the wrong antibiotic including not converting broad-spectrum agents to narrow-spectrum agents when appropriate; and introducing collateral damage against other antibiotics by using an antibiotic that increases resistance pressure.
While some institutions capture microbiologic data by source (i.e. urine vs. systemic) and by location (i.e. outpatient vs. inpatient), few institutions or systems capture isolate specific data by infectious disease diagnosis controlled for pathogen and site of culture. Following these patients allows the capture of associated outcomes which in turn would add important clinical and economic data.
In order to provide useful information to hospital-based clinicians, hospital-specific data must be employed. The utilization of local resistance data is imperative to customize the information and solutions considered by the institution.
