The community-wide dilemma of hospital-acquired drug resistance

Few of us who even casually read the newspaper harbor the long-cherished belief that infectious diseases are a problem of the past. Infectious diseases, even during the most optimistic times, remained the major worldwide source of human mortality. At present ≈17–20 million people die annually of infectious diseases, mostly as a consequence of well recognized diseases: malaria, tuberculosis, and HIV. A recent report (1) highlights the continued and even escalating threat to human health from an expanding list of human pathogens. These threats are largely the consequence of the emergence of novel pathogens into the human population (e.g., SARS-CoV and HIV), the transport of pathogens into novel areas (e.g., West Nile Virus), or the evolution of resistance among pathogens once believed controllable (e.g., antimicrobial-resistant forms of tuberculosis). In the wake of this enormous problem, there has been a renewed effort at constructing mathematical models of the infectious disease process in an attempt to predict disease emergence and the evolution of antimicrobial resistance (2–12). Models of antimicrobial resistance have largely focused on the likelihood and conditions under which resistant pathogenic forms will arise and spread and the identification of measures that should be taken to limit emergence (9–11). Most often these models are targeted at individual patients, and the recommended controls are on the structure of drug delivery or they …