ABSTRACT
Hospitals worldwide are facing a crisis due to the increasingly rapid emergence and dissemination of antimicrobial resistant organisms. Resistance to multiple antimicrobial agents; including methicillin and quinolones among Staphylococcus aureus; has been noted to be an endemic problem in Health care settings. This leaves vancomycin as the sole effective antimicrobial agent for many patients. (1). A similar problem has been noted among the coagulase negative Staphylococci (2). The situation in Uganda is quite similar; the only exception being cost availability of Vancomycin. The drug being toxic may also prove difficult to monitor. Increased use of vancomycin has exerted selective pressure on enterococci which have developed resistance to the agent. (3). Vancomycin resistant enterococci have been noted among clinical isolates in Mulago inspite of lack of use of the agent (Najjuka; personal communication). Enterobacteriaceae; pseudomanas species and other gram-negative bacilli have become increasingly resistant to most frontline antimicrobials including third generation cephalosporins; monobactams; aminoglycosides and quinolones (4;5;6). Strains of pseudomonas and serratia that elaborate extended sptectrum B-lactamases capable of inactivating the cabapenems have been recovered in Japan (7;8). Clinical isolates with similar properties have been noted recently in our set up (Najjuka; personal communication). Resistance to topical antimicrobials such as chlorhexidine gluconate and mupirocin has also been documented . Resistance is not confined to bacteria; use of triazole antifungal agents; fluconazole; has been accompanied by a dramatic increase influconazole resistance among candida species