title: Evolution of antimicrobial resistance and nosocomial infection. Lessons from the Vanderbilt experience.
abstract: The development of antimicrobial resistance by bacteria has had profound effects of the clinical use of antibiotics, especially in hospital-acquired infections. In 1973, a large outbreak of nosocomial infections due to Serratia marcescens began at the Vanderbilt University medical complex, a major characteristic of which was high-level resistance to gentamicin and carbenicillin. Investigation of the outbreak and subsequent in vitro studies have shown that the evolution and epidemiology of this high-level resistance operated at three levels of organizations: (1) dissemination of individual strains, (2) dissemination of a plasmid among different strains and (3) movement of a discrete genetic element, or transposon, between plasmids. The investigations of this outbreak and other studies reviewed support the concept that resistant strains can evoke as a result of R-plasmid exchange within the hospital environment, providing an opportunity for control of this exchange can be interrupted.
mesh_terms: D002228:Carbenicillin / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy*; D004196:Disease Outbreaks; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005839:Gentamicins / Q000494:pharmacology*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000187:drug effects; D010403:Penicillin Resistance; D011815:R Factors; D012706:Serratia marcescens / Q000187:drug effects
chemical_list: D005839:Gentamicins; D002228:Carbenicillin