Infections caused by multidrug-resistant (MDR) microorganisms represent one of the most significant public health challenges globally. Furthermore, the World Health Organization included antimicrobial resistance among the top ten threats to global health in 2019(1). Among pathogenic organisms, bacteria currently account for the largest share of antimicrobial resistance and contribute to the greatest burden of disease(2).
The prevalence of infections caused by MDR microorganisms is rising, and in the absence of effective control measures, these infections could result in up to 10 million additional deaths annually by 20503. Approximately 8% of hospitalized patients develop healthcare-associated infections, and 20% of these are caused by MDR bacteria(2). In intensive care units (ICUs), the rate of MDR bacterial infections can reach as high as 41%, and the mortality attributable to these infections is significantly higher compared to infections caused by non-resistant strains(2). Additionally, recent research indicates that, without appropriate interventions, the annual cost of care for patients with MDR infections could reach as much as 1 trillion US dollars by 20503. Compared to infections caused by susceptible strains, MDR pathogens are associated with longer hospital stays, increased healthcare costs, higher readmission rates, and elevated mortality(2).
A recent study identified five bacterial species with high antimicrobial resistance rates: extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, ESBL-producing Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii(2). ESBL-producing bacteria have shown increasing prevalence both in healthcare settings and in the community(2).
Recent research has focused on genetic mutations that lead to antibiotic resistance, as well as the rationality of empirical treatments. The rigorous implementation of clinical protocols, designed to standardize medical therapy, has been shown to reduce the risk of antimicrobial resistance4. Moreover, antibiotic utilization rates in emergency departments have demonstrated a negative correlation with MDR infection rates(5). Physicians working in emergency settings frequently encounter diagnostic uncertainty and time pressure, both of which may contribute to inappropriate antibiotic use(5). Denny et al. recently reported that approximately 1 in 3 patients assessed in emergency departments received a suboptimal or inappropriate antibiotic regimen5. The most common reasons for deeming an antibiotic prescription inappropriate included the lack of a valid clinical indication, overly broad-spectrum therapy, and unnecessary overlap in antimicrobial coverage(5).
Additional factors influencing MDR infection rates included the number of surgical procedures and the need for emergency resuscitative interventions(2). Surgical procedures may contribute to the incidence of MDR infections through the prophylactic use of antibiotics, which can drive resistance, and through the presence of open wounds or orotracheal intubation, both of which may facilitate the transmission of resistant organisms between patients(2).
Effective control of MDR pathogens in healthcare settings requires a multifactorial approach, which includes strong administrative support for resource allocation, infrastructure improvement, and the implementation of infection prevention measures, alongside educational interventions and the judicious use of antimicrobial agents6. Educational initiatives should aim to increase awareness and engage healthcare personnel, particularly regarding adherence to isolation protocols and hand hygiene practices6. Moreover, antimicrobial stewardship plays a critical role in reducing antimicrobial resistance. These pillars form the foundation for the implementation of effective MDR infection prevention and control programs(6).
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Address for correspondence:
Camelia C. DIACONU
email: drcameliadiaconu@gmail.com
