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Antimicrobial Drug Resistance: Burden, Outcomes, Economics, and
Antibiotic Stewardship
Po-Ren Hsueh
Divisions of Clinical Microbiology and Infectious Diseases, Departments of Laboratory
Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan
University College of Medicine, Taipei, Taiwan
Antimicrobial resistance has become a major health problem worldwide, but marked
variations in resistance profiles of bacterial pathogens are found among countries and
in different patient settings, especially in Asia-Pacific. The emerging problem of
beta-lactamase (ESBL)-producing and/or quinolone-resistant Escherichia coli and
Klebsiella pneumoniae isolates is substantial. Extensively drug-resistant (XDR,
resistant to all antibiotics available but one or two) Gram-negative bacilli of clinical
importance include K. pneumoniae, Pseudomonas aeruginosa, Acinetobacter
baumannii, and Stenotrophomonas maltophilia. Combination therapy with at least one
in vitro active agent for invasive XDRGNB infections is usually recommended.
Antibiotic resistance is not always, but usually, associated with significant morbidity,
longer hospitalization, excess costs and mortality. Excess costs associated with
resistant microorganisms may be due to obligation to use more expensive antibiotics,
longer hospital stay, higher mortality, delayed appropriate antibiotic therapy, and a
necessity to perform surgery. The discovery of new drugs active against
hospital-acquired XDRGNB infections to prevent a future medical, social, and
economic catastrophe is ongoing. In the interim, appropriate use of currently available
antibiotics (antibiotic stewardship) and strict adherence of adequate infection control
policy are crucial.