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May 2015

The Battle Against Antimicrobial ResistanceTime for the Emergency Department to Join the Fight

Author Affiliations
  • 1Section of Pediatric Emergency Medicine, University of Colorado School of Medicine, Aurora
  • 2Departments of Emergency Medicine and Pediatrics, Children’s Hospital Colorado, Aurora
  • 3Section of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York
  • 4Morgan Stanley Children’s Hospital of New York–Presbyterian, New York
  • 5Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento
  • 6University of California, Davis, Medical Center, Sacramento
JAMA Pediatr. 2015;169(5):421-422. doi:10.1001/jamapediatrics.2015.79

We cannot solve our problems with the same thinking we used when we created them.

Albert Einstein

Antimicrobial resistance to common bacterial pathogens poses a substantial threat to pediatric public health.1,2 Years of inappropriate and persistent antibiotic overuse, and consequent selective pressure, has led to the evolution of resistant strains of common bacteria that infect children, such as Escherichia coli, Streptococcus pneumonia, and Staphylococcus aureus. Moreover, the overuse of antibiotics has been implicated as a contributor to childhood morbidities such as asthma and obesity. In response, antimicrobial stewardship (AMS) programs have been created in many institutions.3,4 These AMS programs use a collection of strategies, including guidelines, surveillance, education, and evaluation, to optimize antibiotic use.14 The establishment of AMS programs has resulted in measurable positive effects, including improved selection of appropriate antimicrobials, reduction in adverse effects from unnecessary antibiotic exposure, and even local reductions in the prevalence of resistant bacteria.2,3 Importantly, AMS programs produce substantial institutional cost savings, as high as $900 000 annually.3 Consequently, AMS programs are fully established in many children’s hospitals across the United States.4,5

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