[Multidrug-resistant organisms (MDROs) in healthcare associated infections (H.A.Is): one threat above]

The use of antimicrobials has meant for humanity one of the biggest progresses in our recent History and has enhanced an improvement in living conditions (with different nuances depending on the levels of development). Handling of infectious diseases by curing the patient and limiting the transmissions source has been a very remarkable achievement from Public Health, since the second half of the 20th Century. The antibiotic resistance has been recognized with different levels of attention, but it has been acknowledged from the beginning of the Antibiotics era, with different levels of attention. In this sense Paul Ehlrich (1908), father of modern chemotherapy, observed during the trypanosomiasis treatment that the pathogen emerged as a resistant variant after the use of an arsenical compound. Neuschlosz S. also describes in 1919 the resistance to quinine. But it was in the 20th century, that with the development of the specific investigations, the pharmaceutical industry, the great therapeutic antimicrobial arsenal, the widespread use of such drugs, and the spectacular progress of Medicine, has achieved throughout time (1942-2012) the appearance of the selection of pathogenic bacteria resistant to different antibiotics, classes and families. And with it, the appearance behind selection, of multiresistant (MR) bacterias, and currently as an upward phenomenon, with different geographical characteristics in developed countries. There is a worldwide concern with certain MDRO's, with high microbiological, clinic and prevention interest. Especially, in hospitals, for which Clinical Medicine does not have effective drugs, even of the latest generation. We are observing that even those antibiotics, may be ineffective, with large conse- quences for clinic and Public Health. Nowadays, this fact highly concerns the scientific world and the international organizations. In particular Grampositive and Gramnegative bacterias, non-fermenting BGN's, as the causative agents of hospitals care associated/related infection, can present these characteristics described above. Amongst them, especially are of special concern, MRSA, VRE, GISA, VISA, VRSA, ESBL+ Enterobacteriaceae Carbapenem Resistant, and also Ps. aeruginosa, Acinetobacter baumannii, and S. maltophilia multiresistant. Its microbiological isolation can cause different consequences in morbidity (colonization/infection), lethality, and difficulty in applying antibiotic treatment protocols, especially the empirical ones, and above all, in serious or vulnerable patients in high-risk units. Without forgetting, the possibility of exchange of strains, between areas of different care specialties, hospitals, or long-stay Centers in the community/area. There is an evident risk of therapeutical failure and of transmission and clonal spread, to the extent of producing institutional outbreaks, with varied impacts, that are very difficult to control and eliminate. Certainly, a threat that requires an energetic and an urgent call to action.