Control of nosocomial antimicrobial-resistant bacteria: a strategic priority for hospitals worldwide.

The rapid emergence and dissemination of antimicrobial-resistant microorganisms in hospitals worldwide is a problem of crisis dimensions. The root causes of this problem are multifactorial, but the core issues are clear. The emergence of antimicrobial resistance is highly correlated with selective pressure that results from inappropriate use of antimicrobial agents. Dissemination of resistant organisms is facilitated by person-to-person transmission due to inconsistent application of basic infection control practices by hospital personnel. While control strategies exist, the interventions are not likely to be successful unless hospital leaders assume the responsibility for control of antimicrobial resistance. Strategic goals for the control of resistant organisms should be formulated on the basis of multidisciplinary input from hospital personnel. Processes and outcomes relevant to these strategic goals should be measured, and the resultant data should be used to design, implement, and evaluate systematic measures to increase the appropriate use of antimicrobial agents and basic infection control practices. This approach is as relevant to hospitals in countries with limited resources as it is to in fully industrialized countries.