title: Emerging trends in antibiotic resistance: Implications for emergency medicine.
abstract: BACKGROUND
  Many bacteria are demonstrating increasing levels of resistance to commonly used antibiotics. While this has implications for the healthcare system as a whole, many patients infected with these resistant organisms will initially present to the emergency department (ED). The purpose of this review is to provide a summary of current trends in infections caused by the most clinically relevant resistant organisms encountered in emergency medicine.
  
  
  METHODS
  Bacteria were selected based on the Centers for Disease Control and Prevention's National Action Plan for Combating Antibiotic Resistant Bacteria, and PubMed database.
  
  
  RESULTS
  The following bacteria were included: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, Escherichia coli, carbapenem-resistant Enterobacteriaceae, Neisseria gonorrhoeae, and Pseudomonas aeruginosa. All have shown increasing rates of resistance to one or more of the antibiotics commonly used to treat them. Increasing rates of antibiotic resistance are associated with worse clinical outcomes and greater healthcare costs.
  
  
  CONCLUSIONS
  Antibiotic resistance is increasing and poses significant a risk to both the patient and public health as a whole. Appropriate choice of initial antibiotic is important in improving clinical outcomes, which is often the role of the ED provider. On a broader level, the ED must also take part in institutional efforts such as Antibiotic Stewardship Programs, which have been shown to decrease costs and rates of infection with resistant organisms. Ultimately, a multifaceted approach will be required to curb the threat of antibiotic-resistant bacteria.
authors.affiliation: Department of Emergency Medicine, The George Washington University, Washington, DC, United States; The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States. Electronic address: apourmand@mfa.gwu.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Pourmand
authors.affiliation: Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, United States; Georgetown University School of Medicine, Washington, DC, United States.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: Department of Emergency Medicine, The George Washington University, Washington, DC, United States; The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: Jasani
authors.affiliation: Department of Emergency Medicine, UC Davis, Davis, CA, United States.
authors.forename: Larissa
authors.initials: L
authors.lastname: May
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004635:Emergency Medicine / Q000379:methods* / Q000639:trends*; D006069:Gonorrhea / Q000188:drug therapy*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D017410:Practice Guidelines as Topic; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014481:United States; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents