Antimicrobial resistance in clinics, hospitals and at home

Antibiotic resistance and the rise of illnesses that cannot be treated easily because of drug resistance is a health concern around the world.

CMAJ launches a 6-part series on antibiotic resistance to provide practical treatment guidelines for practicing doctors to manage resistant microbes in 3 settings: the hospital, clinic and home. The current issue features 3 articles on the topic.

An analysis by Dr. David Patrick from the BC Centre for Disease Control and Dr. Jim Hutchinson contains practical guidelines for clinicians to help reduce antibiotic exposure http://www.cmaj.ca/press/pg416.pdf. "Our collective prescriptions constitute an ecological problem that may reduce the success of future therapy," write Dr. Patrick and coauthor. They point out that changes to drug formularies at the institutional level and in reimbursements from provincial drug plans result in the biggest shifts in antibiotic use.

A review by Dr. Andrew Simor at Sunnybrook Health Sciences Centre in Toronto and researchers from the Public Health Agency of Canada focuses on antimicrobial resistance in hospitals, the mechanisms of antibiotic resistance, transmission of these organisms and the impact of antimicrobial resistance http://www.cmaj.ca/press/pg408.pdf. They note that enhanced monitoring, hand washing hygiene and other infection prevention control measures may help limit the increase of antibiotic resistance in Canada.

A commentary http://www.cmaj.ca/press/pg371.pdf. by Canadian public health and infectious disease professionals underscores the point that the management of resistant microbes needs an understanding of the ecological balance between the human and microbial world. "Balancing harm from antimicrobial-resistant organisms and optimal antimicrobial use requires knowledge of local antimicrobial-resistance patterns, thoughtful prescribing in conjunction with the effective use of basic infection control practices, and a firm understanding of the delicate ecological balance in which we co-exist with the microbial world," conclude Dr. Lindsay Nicolle and coauthors.