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The impact of changing pathogens of serious infections in hospitalized patients
1Department of Epidemiology, Rollins School of Public Health of Emory University, and Department of Medicine (Infectious Diseases), Emory University School of Medicine, Atlanta, GA 30322, USA. jmcgowa@sph. emory.edu
Abstract:
New epidemiological patterns are being observed for multidrug-resistant nosocomial organisms. Current problems include the appearance of resistance determinants in organisms that are virulent enough to cause infection in patients with normal host defenses. In addition, multidrug-resistant organisms are spreading from health care to community settings, and organisms from the community are spreading to health care settings. The appearance and spread of resistance can be examined both at a molecular level and on a larger scale involving several pathways. Potential pathways within institutions include the following: introduction of new strains from outside sources (e.g., patients or health care workers from other institutions); exchange of resistance determinants via genetic mutation or transfer of genetic material; emergence or selection of resistant strains following exposure to antimicrobials; and clonal dissemination. Strategies such as multidisciplinary management of infections, appropriate infection control measures, and surveillance of resistance patterns are necessary to address the problem of resistance.
Insights
Multidrug-resistant nosocomial organisms are evolving, spreading between healthcare and community settings. Effective infection control and surveillance are vital to combat these resistant pathogens.
Area of Science:
- Microbiology
- Epidemiology
- Infectious Diseases
Background:
- Emerging epidemiological patterns of multidrug-resistant nosocomial organisms present significant challenges.
- Resistance determinants are appearing in virulent organisms capable of infecting immunocompetent individuals.
- Multidrug-resistant organisms (MDROs) are increasingly crossing between healthcare and community environments.
Purpose of the Study:
- To examine the evolving epidemiological patterns of multidrug-resistant nosocomial organisms.
- To identify key pathways contributing to the emergence and spread of antimicrobial resistance.
- To highlight necessary strategies for combating MDROs.
Main Methods:
- Review of current epidemiological data on multidrug-resistant organisms.
- Analysis of molecular and large-scale pathways of resistance dissemination.
- Identification of institutional pathways including strain introduction, genetic exchange, antimicrobial selection, and clonal spread.
Main Results:
- New epidemiological patterns of multidrug-resistant nosocomial organisms are observed.
- Resistance determinants are found in virulent organisms affecting patients with normal defenses.
- MDROs are spreading bidirectionally between healthcare and community settings.
Conclusions:
- The emergence and spread of MDROs involve complex molecular and institutional pathways.
- Multidisciplinary infection management, robust infection control, and resistance surveillance are crucial.
- Addressing the challenge requires a comprehensive approach to mitigate MDRO spread.