title: Clinical challenges of nosocomial infections caused by antibiotic-resistant pathogens in pediatrics.
abstract: Antibiotic resistance in nosocomial infections is an ever-increasing problem as health care institutions provide care for children with more complicated medical and surgical problems. Several mechanisms of antibiotic resistance are reviewed for both gram-negative and gram-positive nosocomial pathogens. These adaptive resistance mechanisms allow organisms to survive in an environment of extensive antibiotic use and result in clinically significant infections. Mobile genetic elements have facilitated the rapid spread of antibiotic resistance within and among species. The clinical challenge faced by many practitioners is to understand these mechanisms of antibiotic resistance and to develop strategies for successfully treating infection caused by resistant pathogens. Nosocomial outbreaks caused by resistant organisms are described, and an approach to empiric therapy based on presumed pathogens, site of infection, and local resistance patterns is discussed.
authors.affiliation: Division of Infectious Diseases, Children's Hospital and Health Center, San Diego, CA 92123, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Pong
authors.forename: John S
authors.initials: JS
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects* / Q000235:genetics; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D002648:Child; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D022761:Gene Transfer, Horizontal; D006801:Humans; D007223:Infant; D010372:Pediatrics; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents