title: A call for action:  managing the emergence of multidrug-resistant Enterobacteriaceae in the acute care settings.
abstract: OBJECTIVE
  Multidrug-resistant (MDR) Enterobacteriaceae are an emerging and a major concern for the medical community. Reported rates of MDR Enterobacteriaceae are increasing, and infections with these organisms are no longer limited to those associated with healthcare in the severely ill or infirm. Community-acquired infections are now described. The purpose of this review is to provide the readers with an up to date picture of MDR Enterobacteriaceae and to highlight the infection prevention practices that will impede the spread of this public health threat.
  
  
  RESULTS
  The epidemiology of MDR Enterobacteriaceae is rapidly evolving. Among the various MDR Gram-negatives, carbapenemase-producing organisms have been some of the most concerning. Descriptions of the global spread of carbapenemase-producing Enterobacteriaceae, and emerging epidemiology including the findings of the New Delhi metallo beta-lactamase (NDM) in water and other environmental sources, have forced reconsideration of prevention strategies. Similarly, food-borne outbreaks of extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have also caused public health experts to rethink approaches to control their spread. Finally, several articles published in the past year address the challenges and contemporary strategies to combat the MDR Enterobacteriaceae.
  
  
  CONCLUSIONS
  The speed with which the newest resistance genes have disseminated among the different Gram-negative species and around the world is such that it is now considered a global public health crisis. Proposed infection prevention and control practices related to MDR Enterobacteriaceae are primarily 'bundled' and based on clinical case reports derived from outbreak-like situations, on expert opinion and understanding about other Gram-negatives.
authors: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. psavard2@jhmi.edu
authors: Patrice
authors: P
authors: Savard
authors: Trish M
authors: TM
authors: Perl
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000382:microbiology / Q000517:prevention & control; D003422:Critical Care / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015995:Prevalence; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1