Chapter 29 : Epidemiology and Treatment Options for Select Community-Acquired and Nosocomial Antibiotic-Resistant Pathogens

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This chapter outlines the impact of antimicrobial resistance by describing the epidemiology of select antimicrobial-resistant pathogens and the difficulties associated with treatment of infections caused by these organisms. It discusses antimicrobial treatment options for infections caused by resistant enterococci, , , and . The arrival of vancomycin-resistant enterococci (VRE) is often attributed to the overuse of vancomycin, which has increased about 100-fold in the last 20 years, predominantly to treat methicillin-resistant (MRSA), enterococcal, and infections. The most important risk factors for VRE colonization and infection include severe underlying disease, extended hospital stay, and previous antimicrobial exposure. In the absence of literature supporting the use of one agent versus another, linezolid should be used as first line therapy for VRE infections, because it can cover both and . No population or geographical region is immune or isolated from the risk of infection with the primary cause of tuberculosis (TB) . Vaccine candidates that have been developed so far include recombinant Bacillus Calmette-Guérin; attenuated ; subunit and pooled subunit vaccines; fusion polyproteins; and DNA vaccines.

Citation: Gustafson J, Goldman J. 2005. Epidemiology and Treatment Options for Select Community-Acquired and Nosocomial Antibiotic-Resistant Pathogens, p 387-400. In White D, Alekshun M, McDermott P (ed), Frontiers in Antimicrobial Resistance. ASM Press, Washington, DC. doi: 10.1128/9781555817572.ch29
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Table 1

Potential regimens for tuberculosis caused by drug-resistant strains of

Adapted from reference 13. Abbreviations: EMB, ethambutol; FQN, fluoroquinolone; IA, injectable agent; INH, isoniazid; PZA, pyrazinamide; RIF, rifampin; and SM, streptomycin.

Injectable agent may include aminoglycosides or the polypeptide capreomycin. Alternative agents: ethionamide, cycloserine, -aminosalicylic acid, clarithromycin, amoxicillin/clavulanate, and linezolid.

Citation: Gustafson J, Goldman J. 2005. Epidemiology and Treatment Options for Select Community-Acquired and Nosocomial Antibiotic-Resistant Pathogens, p 387-400. In White D, Alekshun M, McDermott P (ed), Frontiers in Antimicrobial Resistance. ASM Press, Washington, DC. doi: 10.1128/9781555817572.ch29

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