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NDM-1 CARRYING ENTEROBACTERIACEAE - NORTH AMERICA, UK ex INDIA, PAKISTAN
- snip -
Organisms carrying this resistance combination have already been introduced
into western Europe, the USA, and Canada.
The best methods of control are
rapid recognition by standard microbiologic methodology in patients having
the appropriate medical/travel history and aggressive handwashing techniques.
The amazing overuse of our current antimicrobial armamentarium that I am
currently observing in my clinical practice in the USA will no doubt serve
as an efficient multiplier of these isolates just as intravenous drug abuse
and sexual promiscuity facilitated the explosion of HIV 30 years ago.
This
misuse, in my opinion, is directly related to the lack of control of
antimicrobial usage in intensive care units and emergency care settings by
intensivists and ER physicians who often react with unwisdom and "cookbook"
protocols instead of using common sense and rational prescribing patterns.
Once the patient moves out of the ICU or ER, the physicians do not even see
the products of their unwise labors.
In the USA, reimbursements for medical care are based on procedures, not
thought processes.
Until the power of therapeutic nihilism is recognized,
that is, using these agents only when rational, in combinations that make
sense, and in settings where therapeutic interventions can have the ability
to produce measurable and meaningful improvement in a patient's life, the
medical community will continue down the slippery slope into an era where
no therapeutic options will exist.
Mod.LL
- snip -
Organisms carrying this resistance combination have already been introduced
into western Europe, the USA, and Canada.
The best methods of control are
rapid recognition by standard microbiologic methodology in patients having
the appropriate medical/travel history and aggressive handwashing techniques.
The amazing overuse of our current antimicrobial armamentarium that I am
currently observing in my clinical practice in the USA will no doubt serve
as an efficient multiplier of these isolates just as intravenous drug abuse
and sexual promiscuity facilitated the explosion of HIV 30 years ago.
This
misuse, in my opinion, is directly related to the lack of control of
antimicrobial usage in intensive care units and emergency care settings by
intensivists and ER physicians who often react with unwisdom and "cookbook"
protocols instead of using common sense and rational prescribing patterns.
Once the patient moves out of the ICU or ER, the physicians do not even see
the products of their unwise labors.
In the USA, reimbursements for medical care are based on procedures, not
thought processes.
Until the power of therapeutic nihilism is recognized,
that is, using these agents only when rational, in combinations that make
sense, and in settings where therapeutic interventions can have the ability
to produce measurable and meaningful improvement in a patient's life, the
medical community will continue down the slippery slope into an era where
no therapeutic options will exist.
Mod.LL
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