title: Emergence of multidrug resistance in bacteria and impact on antibiotic expenditure at a major army medical center caring for soldiers wounded in Iraq and Afghanistan.
abstract: Since the invasions of Iraq and Afghanistan, the epidemiologic traits of clinical isolates at Walter Reed Army Medical Center have shifted toward drug-resistant strains of microorganisms, particularly among the gram-negative bacteria. Moreover, antibiotic prescribing patterns during this period have changed remarkably and mirror the emergence of these organisms at our institution.
authors.affiliation: Department of Medicine, Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. Michael.Zapor@amedd.army.mil
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zapor
authors.forename: Daniel
authors.initials: D
authors.lastname: Erwin
authors.forename: Goldina
authors.initials: G
authors.lastname: Erowele
authors.forename: Glenn
authors.initials: G
authors.lastname: Wortmann
mesh_terms: D000346:Afghanistan; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006095:Gram-Positive Cocci / Q000187:drug effects; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D007493:Iraq; D008826:Microbial Sensitivity Tests; D008889:Military Personnel; D010818:Practice Patterns, Physicians'; D014481:United States; D014857:Warfare
chemical_list: D000900:Anti-Bacterial Agents