Role of antimicrobial stewardship in prevention and control of antibiotic resistance

  • David M. Shlaes


Evidence linking antimicrobial use with resistance is compelling on the local, national, and international levels. That resistance levels can be influenced by changing patterns of use also seems clear. We must now determine how, as a global society, to best use the resource of antimicrobials and how to protect novel compounds that are just now becoming available from emerging resistance. We must act not only within the arena of human use but also on use in animals and for crops.

References and Recommended Reading

  1. 1.
    Shlaes DM, Gerding DN, John JF, et al.: Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: Guidelines for the Prevention of Antimicrobial Resistance in Hospitals. Infect Control Hosp Epidemiol 1997, 18:275–291. The link between antimicrobial use and antimicrobial resistance in large part was used to justify these recommendations.PubMedCrossRefGoogle Scholar
  2. 2.
    Seppala H, Klaukka T, Vuopio-Varkila J, et al.: The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Engl J Med 1997, 337:441–446.PubMedCrossRefGoogle Scholar
  3. 3.
    McGowan JE Jr: Antibiotic resistance in hospital bacteria: current patterns, modes for appearance or spread, and economic impact. Rev Med Microbiol 1991, 2:161–169.Google Scholar
  4. 4.
    McGowan JE Jr: Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis 1983, 5:1033–1048.PubMedGoogle Scholar
  5. 5.
    Olson B, Weinstein RA, Nathan C, et al.: Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 1987, 150:808–816.Google Scholar
  6. 6.
    McGowan JE Jr: Is antimicrobial resistance in hospital microorganisms related to antibiotic use? Bull NY Acad Med 1987, 63:283–268.Google Scholar
  7. 7.
    Levy SB: Balancing the drug-resistance equation. Trends Microbiol 1994, 2:341–342.PubMedCrossRefGoogle Scholar
  8. 8.
    Miller GH, Sabatelli FJ, Hare RS, et al.: Aminoglycoside resistance study groups: the most frequent aminoglycoside resistance mechanisms—changes with time and geographic area—a reflection of aminoglycoside usage patterns? Clin Infect Dis 1997, 24(Suppl 1):S46-S61.PubMedGoogle Scholar
  9. 9.
    Evans RS, Pestonik SL, Classen DC, et al.: A computer-assisted management program for antibiotics and other anti-infective agents. N Engl J Med 1998, 338:232–238.PubMedCrossRefGoogle Scholar
  10. 10.
    Gerding DN, Larson TA, Hughes RA, et al.: Aminoglycoside resistance and aminoglycoside usage: ten years of experience in one hospital. Antimicrob Agents Chemother 1991, 35:1284–1290.PubMedGoogle Scholar
  11. 11.
    Meyer KS, Urbac C, Eagan JA, et al.: Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993, 119:353–358.PubMedGoogle Scholar
  12. 12.
    Rahal JJ, Urban C, Horn D, et al.: Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 1998, 280:1233–1237.PubMedCrossRefGoogle Scholar
  13. 13.
    Rice LB, Eckstein E, DeVente J, Shlaes DM: Ceftazidime-resistant Klebsiella pneumoniae at a Department of Veterans Affairs Medical Center: I. Description of the outbreak, clinical significance and response to replacement of ceftazidime with piperacillin-tazobactam. Clin Infect Dis 1996, 23:118–124.PubMedGoogle Scholar
  14. 14.
    Patterson JE, Hardin TC, Kelly C, et al.: Association of antibiotic utilization measures and control of multiple drug resistance in extended-spectrum B-lactamase-producing Klebsiella pneumoniae [abstract]. In Program of the Annual Meeting of the Infectious Diseases Society of America Denver, 1998.Google Scholar
  15. 15.
    Quale J, Landman D, Saurina G, et al.: Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycinresistant enterococci. Clin Infect Dis 1996, 23:1020–1025.PubMedGoogle Scholar
  16. 16.
    Climo MW, Israel DS, Wong ES, et al.: Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998, 128:989–995.PubMedGoogle Scholar
  17. 17.
    Glynn MK, Bopp C, Dewitt W, et al.: Emergence of multidrugresistant Salmonella enterica serotype typhimurium DT104 infections in the United States. N Engl J Med 1998, 338:1333–1338.PubMedCrossRefGoogle Scholar
  18. 18.
    Klare I, Heier H, Claus H, et al.: Enterococcus faecium strains with vanA-mediated high-level glycopeptide resistance isolated from animal foodstuffs and fecal samples of humans in the community. Microb Drug Resist 1995, 1:265–272.PubMedGoogle Scholar
  19. 19.
    Kirst HA, Thompson DG, Nicas TI: Historical yearly usage of vancomycin. Antimicrob Agents Chemother 1998, 42:1303–1304.PubMedGoogle Scholar
  20. 20.
    Werner G, Klare I, Witte W: Association between quinupristin/ dalfopristin resistance in glycopeptide resistant Enterococcus faecium and the use of additives in animal feed. Eur J Clin Microbiol Infect Dis 1998, 17:401–402. The long-term efficacy of quinupristin-dalfopristin is threatened by the use of pristinamycin in animal feed.PubMedGoogle Scholar
  21. 21.
    Ridley A, Threlfall EJ: Molecular epidemiology of antibiotic resistance genes in multiresistant Salmonella typhimurium DT104. Microb Drug Resist 1998, 4:113–118.PubMedCrossRefGoogle Scholar
  22. 22.
    Department of Health and Human Services, Food and Drug Administration: Guidance for the Industry: evaluation of the human health impact of the microbial effects of antimicrobial new animal drugs intended for use in food-producing animals. Fed Reg 1998, 63:64094–64106. These recently published guidelines evaluate the human health impact of the microbial effects of antimicrobial drugs intended for use in food-producing animals.Google Scholar

Copyright information

© Current Science Inc 1999

Authors and Affiliations

  • David M. Shlaes
    • 1
  1. 1.Infectious Disease ResearchWyeth-Ayerst ResearchPearl RiverUSA

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