Antiobiotic stewardship-At present, the multifaceted etiology of antibiotic resistance has many factors which are at play. These include inadequate regulations and usage imprecision, awareness deficiency in best practices which steers undue use of antibiotics, use of antibiotics as a poultry and livestock growth promoter rather than to control infection, and online marketing which made the unrestricted availability of low-grade antibiotics very accessible. ANTIBIOTIC RESISTANCE-When antibiotics are not given wisely or there is overuse of these, resistance bacteria emerge Emergence of MRSA and MDRO-Bacteria multiply rapidly and mutations arise regularly. Segments of DNA can be transferred by transformation. Antibiotics' overuse, misuse and abuse favor the emergence and survival of resistant organisms. The misuse of antibiotics includes failure to take the prescribed course of the antibiotics or to take the course of treatment at incorrect daily intervals. The replication of organisms that have accidentally developed mechanisms to avoid destruction can pose a serious threat to the successful treatment of infections. The basis of drug resistant may be genetic or nongenetic. The transmission of resistance could be by transformation, conjugation and mutations. Infections because of MRSA and MDRO may cause infections in any part of the body, including bloodstream, urinary tract, lungs, skin, wounds or surgical site. Risk Factors for MRSA and MDRO Infections- Repeated hospitalization or regular dialysis visits Existing colonization with MDRO An underlying disease or condition such as chronic kidney disease, diabetes, or skin lesions Previous prolonged use of antibiotics An existing acute illness Prolonged stay in the hospital Elderly or a patient on immune-suppressing medicine Patient has experienced invasive procedures, such as dialysis, use of medical devices, urinary catheters, or nasogastric tubes used to give medicines, fluids, or nutrients Prevention-The infections because of MRSA and MDRO are hard to treat as they do not respond to common antibiotics. Based on the isolated organism in clinical specimen, best antibiotic for treatment is chosen. "Centers for Disease Control and Prevention (CDC) recommends that if you are prescribed antibiotics, you follow the doctor's instructions." One of the best ways to control MRSA and MDRO infection is to perform hand hygiene with soap and water for at least 20 seconds.

3. NEED OF ANTIMICROBIAL STEWARDSHIP
 At present, the multifaceted etiology of
antibiotic resistance has many factors which are
at play.
 These include inadequate regulations and usage
imprecision, awareness deficiency in best
practices which steers undue use of antibiotics,
use of antibiotics as a poultry and livestock
growth promoter rather than to control
infection, and online marketing which made the
unrestricted availability of low-grade antibiotics
very accessible.

4. ANTIBIOTIC RESISTANCE
 When antibiotics are not given wisely or there
is overuse of these, resistance bacteria
emerge (Fig. 38.3).

5. Emergence of MRSA and MDRO
 Bacteria multiply rapidly and mutations arise
regularly.
 Segments of DNA can be transferred by
transformation.
 Antibiotics' overuse, misuse and abuse favor the
emergence and survival of resistant organisms.
 The misuse of antibiotics includes failure to take
the prescribed course of the antibiotics or to take
the course of treatment at incorrect daily
intervals.

6.  The replication of organisms that have accidentally
developed mechanisms to avoid destruction can
pose a serious threat to the successful treatment of
infections.
 The basis of drug resistant may be genetic or
nongenetic.
 The transmission of resistance could be by
transformation, conjugation and mutations.
 Infections because of MRSA and MDRO may cause
infections in any part of the body, including
bloodstream, urinary tract, lungs, skin, wounds or
surgical site.

7. Risk Factors for MRSA and MDRO
Infections
 Repeated hospitalization or regular dialysis visits
 Existing colonization with MDRO
 An underlying disease or condition such as chronic
kidney disease, diabetes, or skin lesions
 Previous prolonged use of antibiotics
 An existing acute illness
 Prolonged stay in the hospital
 Elderly or a patient on immune-suppressing medicine
 Patient has experienced invasive procedures, such as
dialysis, use of medical devices, urinary catheters, or
nasogastric tubes used to give medicines, fluids, or
nutrients

8. Prevention of MRSA and MDRO
 The infections because of MRSA and MDRO are hard
to treat as they do not respond to common
antibiotics.
 Based on the isolated organism in clinical specimen,
best antibiotic for treatment is chosen. "Centers for
Disease Control and Prevention (CDC) recommends
that if you are prescribed antibiotics, you follow the
doctor's instructions."
 One of the best ways to control MRSA and MDRO
infection is to perform hand hygiene with soap and
water for at least 20 seconds.

9.  If one has to visit a person in a healthcare
setting, then:
 Wash your hands on entering, and before
leaving the person's room.
 Wear disposable gloves if potential contact with
bodyfluids (blood, urine, pus, vomit, saliva,
feces, etc.) can be there.
 Gowns should be worn if a contact with body
fluids is anticipated.

10. Outside a healthcare setting, the CDC recommends
that:
 Towels used for drying hands should be washed
before reusing.
 Bed sheets must be changed and washed if soiled on
a regular basis.
 The patient's environment should be cleaned as a
routine.
 A commercial disinfectant or a solution of 1/4 cup of
regular household bleach in 1 gallon of water is best
for this.

11.  Wash hands with soap and warm water before and
after physical contact with the person, and before
leaving the person's home.
 Wear disposable gloves if potential contact with
body fluids (blood, urine, pus, vomit, saliva, feces,
etc.) can be there.
 Hands should be washed after removing the gloves.
 Physician and other health care personnel providing
care to the patient are notified that the patient is
infected with a MDRO or MRSA.