Antimicrobial resistance and its control in pediatrics

The scope and magnitude of antimicrobial resistance among nosocomial pathogens have increased dramatically in recent years. The most prevalent problems among pediatric patients are Enterobacter, Klebsiella, and other gram-negative enteric bacilli resistant to broad-spectrum penicillins and third-generation cephalosporins; methicillin-resistant coagulase-negative staphylococci; and multidrug-resistant Pseudomonas aeruginosa. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci also are important problems, but they are still focal in their distribution. Multiple factors affect the emergence, selection, amplification, and dissemination of resistance determinants, not the least of which is the incredible capacity of bacteria to spread genes coding for resistance determinants within and among species. Inadequate infection control practices and overuse of antimicrobial agents are the important modifiable factors. Improved use of barrier precautions and alcohol-based waterless hand rubs and reduced use of broad-spectrum antimicrobial agents have been shown to reduce infection or colonization with resistant bacteria. However, more research - including more randomized controlled trials - is needed to devise strategies to effectively combat this problem.