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Archives of General Internal Medicine | Volume 2
&
April 04-05, 2018 | Miami, USA
International Conference on
Internal Medicine & Practice and Primary Care
International Meeting on
Breast Pathology & Cancer Diagnosis
A
ntimicrobial resistance (AMR) is one of the greatest
clinical challenges in modern medicine. It has been
precited that by 2050 mortality due to AMR will exceed
10 million with excess costs of $100 trillion (O’Neil report
2016). The majority of infections are treated empirically
in the community setting. In the US, the most frequent of
bacterial infections are skin and respiratory and urinary
tract infections. The most common bacterial causes of
these infections are
Staphylococcus aureus
(methicillin
susceptible and methicillin resistant) and Gram-negative
species,
Streptococcus pneumoniae
and
Escherichia
coli
respectively. Each of the species has significant resistance
challenges often leading to adverse outcomes, both clinical
and economic. Current empiric antibiotics are frequently
inadequate to cover the predominant pathogens or have
a challenging adverse event profile. Empiric therapy for
skin infections should encompass MRSA (40-50% of staph
isolates) and in certain patients Gram negative pathogens
(which occur in almost 40% of infections), macrolide resistant
pneumococcus (40%) and trimethoprim/sulphamethoxazole
(>30%) and fluoroquinolone
Escherichia coli
(10-15%) in
urinary tract infections. Failure of initial empiric therapy is
assessed by one of four outcomes, a need for extra initial
antibiotics, a second course of different class, need to visit
the urgent care clinic or the emergency department (with
or without admission). In addition to clinical failure these
outcomes have a clear economic impact.
e:
gtillotsonconsult@yahoo.comIncreasing antimicrobial resistance: Clinical and other outcomes in community infections
Glenn S Tillotson
GST Micro LLC, USA