ABSTRACT
This chapter focuses on antimicrobial resistance and the importance of administering initial appropriate antimicrobial treatment for serious infections as it applies to hospital-acquired infections, especially hospital-acquired pneumonia. One of the consequences of greater antimicrobial resistance is an increased recognition of inappropriate antimicrobial treatment of infections. Inappropriate antimicrobial treatment represents the use of antibiotics with poor or no in vitro activity against the identified microorganisms causing infection at the tissue site of infection. The goal of targeted antimicrobial therapy is to avoid the administration of unnecessary antibiotic treatment. This first requires narrowing the antimicrobial coverage after identification of the pathogen to which the infection is attributed and the microorganism’s antimicrobial susceptibility profile. Antibiotic practice guidelines or protocols have emerged as a potentially effective means of both avoiding unnecessary antibiotic administration and increasing the therapeutic effectiveness of the agents. The concept of antibiotic class cycling or rotation has been advocated as a potential strategy for reducing the emergence of antimicrobial resistance.
