UNDERSTANDING AND MANAGING MICROBIAL RESISTANCE IN INSTITUTIONAL SETTINGS

Patient factors that contribute to resistance are identified, the conc ept of the ''genesis patient'' is explained, and strategies for preven ting or overcoming resistance are described. Technology makes it possi ble to support medically compromised patients. These patients, called genesis patients, cannot clear mutant organisms that develop resistanc e, and they become focal points for the emergence and spread of resist ant organisms. Strategies to control the emergence of resistance in in stitutional settings must take into consideration the unique role of g enesis patients. A wide range of patient- and antibiotic-related facto rs must be considered. Suboptimal dosing clearly plays a role in the d evelopment of resistance. A formulary that seeks to curtail expenses b y severely limiting antimicrobial choices may actually drive costs up because it contributes to the emergence of resistance. The best formul ary strategy may be to include a wide variety of antimicrobials from a ll available classes. Particularly in genesis patients, real-time surv eillance to ensure timely, effective antimicrobial therapy is essentia l.