Clinical significance of the emergence of bacterial resistance in the hospital environment

Abstract

1. Summary, 90S 2. Introduction, 90S 3. Is antibiotic resistance increasing in hospitals?, 91S 4. Where does resistance come from?, 91S 4.1. Genetics and ecological perspectives, 91S 4.2. Sources within the hospital, 91S 4.3. Sources external to the hospital, 92S 5. What are the effects on treatment of individual patients?, 93S 6. What are the wider effects on hospital practice?, 93S 6.1. Laboratory workload, 93S 6.2. Antibiotic usage, 94S 6.3. Infection control, 94S 6.4. Cleaning, 95S 6.5. Clinical governance, 95S 7. Conclusions, 95S 8. References, 96S Antibiotic resistance is an increasing threat in hospitals and both morbidity and mortality from infections are greater when caused by drug‐resistant organisms. Whilst hospitals are universally blamed for this increase, there is an insufficient appreciation of external sources of resistance, such as when patients are admitted to hospitals from long‐term care facilities in the community. The use of antibiotics in family practice and animal husbandry has also been linked to drug resistance being encountered in the hospital setting. Justifiable hospital antibiotic use, which can be life saving, may lead to `collateral damage' with the emergence of resistance in non‐target bacteria in the bowel, for example, with subsequent spread by cross‐infection. At a management level, antibiotic resistance can have a significant impact on the ability of hospitals to maintain services since cohorting of patients and ward closures from outbreaks add to continuing bed shortages and waiting lists. Hospital laboratories must review their standard operating procedures since some resistance mechanisms may be missed by current methods of antibiotic susceptibility testing. With increasing public concern from press reports of `multiresistant Staphylococcus aureus killer virus' and other drug‐resistant organisms, there will inevitably be a push by national authorities for more surveillance data on antibiotic resistance; however, the cost‐effectiveness of different surveillance strategies should be considered. Clinical governance and risk management are dominant themes in the National Health Service and hospital hygiene and antibiotic resistance are likely to feature prominently in audits related to these themes in the near future.