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Project ICARE Background
Antimicrobial Resistance
Antimicrobial resistance is a global concern. Organisms that are resistant to
different antimicrobials have increased during the past few years. Data from
this study, Project ICARE, show that multi-drug resistant bacteria now cause
an increasing number of infections each year (1).
New patterns of resistance develop quickly, especially in hospital intensive
care units (ICUs). Thus, it is crucial to know in a timely fashion the specifics
of their occurrence and to develop strategies and drugs for control and treatment.
Laboratory recognition of antimicrobial resistant organisms is imperative.
Surveillance for Resistance
Information from Project ICARE (2)
and WHO-EQAS (3) has
shown that many laboratories have trouble identifying resistant organisms,
and that the problems extend to both over-detect and under-detect resistance.
Such inaccuracies produce the following two effects:
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They prevent use of specific drugs in patients with illnesses for which
these drugs could be useful
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They give a false impression of the relative frequency of resistance
in a given institution, with adverse consequences for formulary decisions.
Surveillance for Resistance Mechanisms
Knowing the resistance mechanisms of an organism is critical both to selection
of alternative therapy and to infection control measures. Identification of
resistance mechanisms of current importance depends on accurate and timely
information on occurrence and etiology of healthcare system infection. However,
currently it is difficult to determine the mechanisms by which resistance
is occurring. Clinical microbiology laboratories at most hospitals lack the
specialized instruments and resources to evaluate newer resistance mechanisms.
References
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Fridkin SK, Steward CD, Edwards JR, Pryor ER, McGowan JE, Jr., Archibald
LK, et al. Surveillance of antimicrobial use
and antimicrobial resistance in United States hospitals: Project ICARE
phase 2. Clin Infect Dis 1999;29:245-252.
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Tenover FC, Raney PM, Williams PP, Britain KL, Steward CD, Fridkin SK,
Gaynes RP, McGowan JE Jr. Mechanisms of extended-spectrum
cephalosporin resistance in Escherichia coli isolates from 26 United States
hospitals collected during Project ICARE. Abstracts of the 40th Interscience
Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Toronto,
Canada, September 17-20, 2000, abstract 1606.
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Tenover FC, Mohammed MJ, Stelling J, O'Brien T, Williams R. Ability
of laboratories to detect emerging antimicrobial
resistance: proficiency testing and quality control results from the World
Health Organization's External Quality Assurance System for antimicrobial
susceptibility testing. J Clin Microbiol 2001;39:241-250.
For more recent ICARE publications on this topic, click on "publications" in left hand column.
PHASE V OF PROJECT ICARE IS SPONSORED IN PART BY:
© 2007 ICARE, All rights reserved.
For all problems or questions regarding this website
please contact Dr. John McGowan at jmcgowa@sph.emory.edu
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