ABSTRACT
COLLATERAL DAMAGE: Implies negative ecological effects of antibiotic therapy, characterized by the selection of resistant microorganisms and adverse colonization or injections with their multi-resistant species. MICROBIAL RESISTANCE: Is mediated by various mechanisms, the presence of which is determined by the nature of antibiotic effects and origin of the agent. Its most important aspect is multiple resistance, most commonly conditioned by the presence of several different resistance genes localized in the form of common units on gene transport elements (integrons, transposons, plasmids). It is further developed by way of mutation-guided alterations in the environments with a strong, selective antibiotic pressure, such as hospital conditions. HOSPITAL INFECTIONS: Bacteremias and pneumonias, above all, are nowadays the principal cause of hospital morbidity and mortality. More than 70% of agents causing them are resistant to at least one of the antibiotics to which they were sensitive once, and multi-resistance is their very common feature as well. Currently valid recommendations for the treatment of nosocomial bacteremias and pneumonias are the empirical application of broad spectrum antibiotics, de-escalation treatment, short therapy course. use of bactericidal antibiotics, and optimization of their pharmacodynamics. in that regard, a combined treatment with carbapenems and glycopeptides reduces the probability of inadequate onset of treatment and the risk of further development of microbial resistance (in some cases it also mediates the establishment of earlier sensitivity), it shortens treatment time, and reduces treatment costs. Further improvement of such a treatment involves a possible adjustment to the well known and regularly monitored local incidence and resistance of microbial agents.
