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Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens
1Antimicrobics Investigation Branch, Centers for Disease Control, Atlanta, Georgia 30333.
Abstract:
Nosocomial pathogens frequently are resistant to antimicrobial agents. Although methicillin-resistant strains of Staphylococcus aureus continue to be a major problem in many hospitals, several new types of resistance determinants have been noted among organisms causing hospital-acquired infections. The mechanisms include extended spectrum beta-lactamases in gram-negative bacilli; resistance to beta-lactams, glycopeptides, and high levels of aminoglycosides among enterococci; quinolone resistance in isolates of methicillin-resistant S. aureus; and the spread of multiple resistance genes simultaneously in gram-negative organisms via Tn21-related genetic elements. These novel mechanisms of resistance complicate the treatment of nosocomial infections by limiting the number of effective antimicrobial agents available to the clinician. It is important for infection control practitioners and microbiologists to work together to detect and control the spread of resistant pathogens in the hospital setting.
Insights
Emerging antimicrobial resistance in nosocomial pathogens, including methicillin-resistant Staphylococcus aureus, complicates treatment. New resistance mechanisms require enhanced infection control collaboration to combat resistant organisms.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Nosocomial pathogens exhibit increasing resistance to antimicrobial agents.
- Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant hospital-acquired infection concern.
- Novel resistance determinants are emerging in various hospital-acquired pathogens.
Purpose of the Study:
- To highlight emerging antimicrobial resistance mechanisms in nosocomial pathogens.
- To underscore the challenges these resistances pose to clinical treatment.
- To emphasize the need for collaborative infection control efforts.
Main Methods:
- Review of current literature on antimicrobial resistance in hospital-acquired infections.
- Identification and description of novel resistance mechanisms.
- Analysis of the clinical implications of these resistance patterns.
Main Results:
- Emerging resistance includes extended-spectrum beta-lactamases in gram-negative bacilli.
- Enterococci show resistance to beta-lactams, glycopeptides, and high-level aminoglycosides.
- Quinolone resistance in MRSA and simultaneous spread of multiple resistance genes in gram-negative organisms via Tn21-related elements are noted.
Conclusions:
- Novel resistance mechanisms limit effective antimicrobial treatment options for nosocomial infections.
- Close collaboration between infection control practitioners and microbiologists is crucial.
- Detection and control of resistant pathogen spread in hospitals are essential.