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The Microbial Genetics of Antibiotic Cycling

Published online by Cambridge University Press:  02 January 2015

Joseph F. John Jr.  and
Louis B. Rice
Joseph F. John Jr.*
Affiliation:
Division of Allergy, Immunology, and Infectious Diseases, Robert Wood Johnson Medical School, New Brunswick, New Jersey
Louis B. Rice
Affiliation:
Division of Infectious Diseases, Department of Medicine, Case Western Reserve School of Medicine, Cleveland Department of Veterans' Affairs Medical Center, Cleveland, Ohio
*
1 RWJPl, 356 MEB, UMDNJ/RWJMS, New Brunswick, NJ 08903-0019
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Abstract

Cycling of currently available antibiotics to reduce resistance is an attractive concept. For cycling strategies to be successful, their implementation must have a demonstrable impact on the prevalence of resistance determinants already dispersed throughout the hospital and associated healthcare facilities. While antibiotic use in hospitals clearly constitutes a stimulus for the emergence of resistance, it is by no means the only important factor. The incorporation of resistance determinants into potentially stable genetic structures, including bacteriophages, plasmids, transposons, and the more newly discovered movable elements termed integrons and gene cassettes, forces some degree of skepticism about the potential for such strategies in institutions where resistance determinants are already prevalent. In particular, the expanding role of integrons may pose an ultimate threat to formulary manipulations such as cycling. Despite these concerns, the crisis posed by antimicrobial resistance warrants investigation of any strategy with the potential for reducing the prevalence of resistance. Over the next decade, new studies with carefully designed outcomes should determine the utility of antibiotic cycling as one control measure for nosocomial resistance.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue S1 , January 2000 , pp. S22 - S31
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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