Antimicrobial Resistance or Increased Antimicrobial Resistance Rates Which One is Reality?

Abstract

Submit Manuscript | http://medcraveonline.com Only antimicrobial stewardship cannot solve this problem, just decreases the rates little. Hospitals, long-term care facilities, nursing home facilities where antibiotics are often and excessively used antimicrobials have a local flora that is being formed by resistant organisms. Two main problems about AR are the emergence of resistant microbial flora at the first step, and then spreading of those bacteria by living and inanimate objects. So, what should be done? Antimicrobial stewardship decreases selection of resistant microorganisms. Most of the physicians are pressed to prescript an antibiotic by patients or their relatives due to upper respiratory tract infections that commonly occur by virus, bacteriuria that is generally colonization secondary to invasive intervention and not needed antibiotic, and broader spectrum and expensive antibiotics justifications of resistance rates of other regions. Physicians do not feel comfortable for fear of malpractice, lawsuits, and inadequate treatment. Pediatricians commonly feel themselves under pressure of families of children to prescribe an antibiotic to relief their concerns about infections. A leukocyte in the urine test or simple symptom of upper respiratory tract infection pushes the doctor to prescribe a thirdgeneration cephalosporin antibiotic that is effective in the urinary system infections. Founder and organizer of the health care system should provide antimicrobial stewardship by guidelines and supporting physicians to prescript narrower spectrum antibiotics and law enforcement that helps them to feel more comfortable in writing prescriptions for fewer antibiotics. In the data analysis of theTruven Health Market Scan Hospital Drug Database that comprised data from approximately 300 hospitals and more than 34 million discharges, from January 1, 2006, to December 31, 2012 in the United States, overall antibiotic use did not change significantly over time, 55.1% of patients received at least one dose of antibiotics during a hospital stay, and the overall days of therapy was 755 per 1000 patient-days.The significant decreases were recorded in the use of fluoroquinolones, aminoglycosides, first and second generation cephalosporins, sulfa antibiotics, metronidazole, and penicillins, with the greatest decrease seen among fluoroquinolones. The significant increases were recorded in the use of third and fourth generation cephalosporins, macrolides, glycopeptides, β-lactam/β-lactamase inhibitor combinations, carbapenems, and tetracyclines [3]. This study also reveals that antimicrobial stewardship is not at the aimed level.