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Antibiotic resistance among bacteria is a consequence of genetic selection of the surviving bacteria in patients treated with various antibiotics. These resistance genes become commonplace especially if carried by bacteria infecting viruses. The emergence of these bacteria is mainly seen in hospitals and other healthcare facilities. Indeed, a major risk factor from hospital admission is acquiring a multiple antibiotic resistant bacterial infection. The phenomenon is well documented among Staphylococcus aureus. Originally highly susceptible to penicillin type antibiotics (known as beta-lactams and commonly represented by the antibiotic methicillin), many hospital acquired Staphylococcus aureus are now methicillin resistant. In addition, they are resistant to many other types of antibiotics commonly used in the hospital setting. Examples of resistance to the toxic "antibiotic of last resort" (vancomycin) are now showing up in Staphylococcus aureus and other bacteria in certain hospitals. The PVL toxin producing Staphylococcus aureus has started on the path of becoming antibiotic resistant. At present most community associated isolates are resistant to methicillin (CA-MRSA). In time, they will surely become resistant to a wider range of antibiotics by simply exchanging genetic information with hospital associated bacteria (HA-MRSA). The only barrier left to widespread severe infection, is the normally non-tissue invasive quality of Staphylococcus aureus. Influenza infection can provide such an opportunity by destroying the cells lining the air passages. Examples of fatal illness from a combination of regular influenza with CA-MRSA have been reported with little emphasis of a portend of what could occur in the face of an influenza epidemic and multiple antibiotic resistant, PVL toxin producing bacteria. Worse still, this is but one example of the enormous risks posed by pathogens teaming up in a biological warfare against mankind and his animals. What should be done? Foremost is an all out attack on the emergence of toxin producing and/or multiple antibiotic resistant bacteria. Financial incentives exist for developing additional antibiotics to replace those for which resistance has developed. This approach should give way to a more common sense approach of preventing infection through decontaminating areas in which harmful bacteria reside. A lack of awareness of decontamination strategies among Government and public health officials is apparent in their recommendations of simply using alcohol hand washing and short acting oxidizing agents such as bleach. Far more preferable is to use agents such as phenols and their derivatives that can retain antibacterial activity over many months. Surveillance for toxin producing and antibiotic resistant bacteria need to be in place in hospitals and settings where large numbers of individuals assemble. Examples include jails, schools, churches, sporting amenities, and workplaces where skin trauma is likely to be encountered. A comprehensive hygiene program, such as the one offered by Preventec inc., in Atlanta GA, should be instituted at such facilities and its effects monitored.
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