By J. Todd Weber
Combating, controlling and treating drug-resistant infections is among the significant demanding situations in glossy drugs. "Antimicrobial Resistance" is going past basic definitions and microbiological information to completely discover this speedily altering zone, describing proof for potent interventions, bills, remedy recommendations and instructions for destiny learn. each one bankruptcy offers crucial history and examines the proof for an enormous element of prevention and regulate, therapy method or coverage choice. Prevention and regulate techniques are analyzed for irrelevant antimicrobial use, fluoroquinolone-resistant organisms, health-care linked infections and parasitic ailments. moreover, remedy ideas for altering resistance styles are explored for community-acquired pneumonia in the course of an influenza pandemic and infections with community-associated MRSA, extended-spectrum beta-lactamase generating organisms and fungi. facts for coverage making are awarded in articles that aspect the prices of antimicrobial-resistant infections in healthcare settings and the specter of resistance with the creation of antiretroviral treatment for big populations within the constructing international. those studies exhibit the place interventions, surveillance and examine may be most valuable sooner or later. "Antimicrobial Resistance" is a useful contribution for infectious ailment physicians and public well-being officers who're drawn to the prevention of antimicrobial-resistant infections.
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Additional resources for Antimicrobial Resistance: Beyond the Breakpoint (Issues in Infectious Diseases)
In Gram-positive bacteria the first-step mutantions typically occur in topoisomerase IV, particularly parC, with subsequent mutations in gyrA and parE . Altered access of the drugs to the target is a second mechanism of quinolone resistance [4–6]. The combination of alteration in drug entry and mutations in the topoisomerase enzymes can result in full fluoroquinolone resistance with MICs ≥4 μg/ml . Resistance to quinolones can also be mediated by qnrA, qnrB and qnrS genes, which are carried on transferable plasmids.
The European Committee for Antimicrobial Susceptibility Testing (EUCAST) has recognized this and altered breakpoints for cephalosporins against Enterobacteriaceae. EUCAST continues to recommend ESBL detection by clinical microbiology laboratories, given the important infection control/epidemiologic impact of ESBL-producing organisms. Treatment of Infection with ESBL-Producing Organisms In vitro, the carbapenems (including imipenem, meropenem, doripenem and ertapenem) have the most consistent activity against ESBL-producing organisms because of their stability to hydrolysis by ESBLs.
Ann Intern Med 1989;110: 873–881. 66 Taylor ME, Oppenheim BA: Selective decontamination of the gastrointestinal tract as an infection control measure. J Hosp Infect 1991;17:271–278. 67 Paterson DL, Singh N, Rihs JD, Squier C, Rihs BL, Muder RR: Control of an outbreak of infection due to extended-spectrum beta-lactamase-producing Escherichia coli in a liver transplantation unit. Clin Infect Dis 2001;33:126–128. Paterson · Doi 68 Hollander R, Ebke M, Barck H, von Pritzbuer E: Asymptomatic carriage of Klebsiella pneumoniae producing extended-spectrum beta-lactamase by patients in a neurological early rehabilitation unit: management of an outbreak.
Antimicrobial Resistance: Beyond the Breakpoint (Issues in Infectious Diseases) by J. Todd Weber