### 1. Introduction to Hospital-Resistant Bacteria
#### **Definition of Resistant Bacteria**
- **Antibiotic Resistance**: Antibiotic-resistant bacteria are microorganisms that have evolved mechanisms to evade the effects of drugs that would normally kill them or inhibit their growth. This resistance occurs when bacteria develop or acquire genetic mutations that render standard antibiotics ineffective.
- **Mechanisms of Resistance**: The mechanisms by which bacteria become resistant include genetic mutations, acquisition of resistance genes from other bacteria through horizontal gene transfer, and the production of enzymes that deactivate antibiotics. These changes enable bacteria to survive in the presence of antibiotics that would normally be lethal.
#### **Importance of the Issue**
- **Impact on Public Health**: The rise of antibiotic-resistant bacteria poses a significant threat to public health. Infections caused by these bacteria are more difficult to treat, leading to longer hospital stays, more complex treatment regimens, and higher healthcare costs. Additionally, these infections can result in increased morbidity and mortality rates.
- **Challenges in Treatment**: The effectiveness of existing antibiotics is diminishing as resistance spreads. This challenge creates a scenario where previously treatable infections become untreatable, leading to the need for stronger, more toxic, or less effective antibiotics.
- **Burden on Healthcare Systems**: Hospitals face substantial burdens due to the prevalence of resistant bacteria. The need for more advanced infection control measures, isolation protocols, and prolonged treatment courses increases the strain on healthcare resources. This situation also exacerbates the problem of healthcare-associated infections (HAIs), which are infections patients acquire while receiving treatment for other conditions.
- **Global and Local Impact**: Antibiotic resistance is a global issue, but its impact can vary locally depending on factors such as the prevalence of resistant strains in the community, the effectiveness of local infection control practices, and the availability of alternative treatments. Understanding the local epidemiology of resistant bacteria helps in tailoring effective strategies to combat their spread.
### 2. Common Types of Hospital-Resistant Bacteria
#### **Methicillin-Resistant Staphylococcus aureus (MRSA)**
- **Overview**: MRSA is a strain of Staphylococcus aureus that is resistant to methicillin and other beta-lactam antibiotics. It is a major cause of healthcare-associated infections.
- **Infections**: MRSA can cause a range of infections, from skin and soft tissue infections to more severe conditions such as bloodstream infections, pneumonia, and surgical wound infections.
- **Transmission**: MRSA spreads through direct contact with infected wounds, contaminated surfaces, or shared items. It can also spread via person-to-person contact in healthcare settings.
- **Prevention and Control**: Measures include strict hygiene practices, screening and isolating infected patients, and ensuring proper use of antibiotics. Healthcare workers are advised to follow infection control protocols to minimize the risk of MRSA transmission.
#### **Vancomycin-Resistant Enterococcus (VRE)**
- **Overview**: VRE refers to enterococci bacteria that have developed resistance to vancomycin, a powerful antibiotic used to treat serious infections.
- **Infections**: VRE commonly causes urinary tract infections, bacteremia, and infections of wounds and surgical sites. It can be particularly problematic in immunocompromised patients.
- **Transmission**: VRE spreads through contact with contaminated surfaces or hands of healthcare workers. It can persist in the environment, making control efforts more challenging.
- **Prevention and Control**: Strategies include maintaining rigorous hand hygiene, using personal protective equipment, and cleaning and disinfecting patient care environments. Surveillance and isolation of infected patients are also crucial.
#### **Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria**
- **Overview**: ESBL-producing bacteria are capable of breaking down a wide range of beta-lactam antibiotics, including penicillins and cephalosporins. These bacteria include strains of Escherichia coli and Klebsiella pneumoniae.
- **Infections**: ESBL-producing bacteria are associated with urinary tract infections, intra-abdominal infections, and bloodstream infections. These infections can be severe and difficult to treat.
- **Transmission**: The spread occurs through contact with contaminated surfaces, hands, or medical equipment. Patients with compromised immune systems or those undergoing invasive procedures are at higher risk.
- **Prevention and Control**: Effective control measures include practicing good hand hygiene, implementing contact precautions, and ensuring proper disinfection of medical equipment. Antibiotic stewardship programs are also important in managing ESBL infections.
#### **Carbapenem-Resistant Enterobacteriaceae (CRE)**
- **Overview**: CRE are a group of bacteria resistant to carbapenems, which are considered last-resort antibiotics for treating multidrug-resistant infections. This group includes Klebsiella pneumoniae and Escherichia coli.
- **Infections**: CRE can cause severe infections such as pneumonia, bloodstream infections, and infections of the urinary tract. These infections are often associated with high mortality rates.
- **Transmission**: CRE spread through contact with contaminated surfaces or hands, and can be transmitted in healthcare settings, particularly in patients with invasive devices.
- **Prevention and Control**: Control measures focus on rigorous infection control practices, including hand hygiene, isolation of infected patients, and the use of personal protective equipment. Surveillance and careful monitoring of antibiotic use are also critical in controlling CRE spread.
#### **Acinetobacter baumannii**
- **Overview**: Acinetobacter baumannii is a gram-negative bacterium known for its ability to develop resistance to multiple antibiotics, including carbapenems.
- **Infections**: This bacterium is often responsible for infections in critically ill patients, such as ventilator-associated pneumonia, bloodstream infections, and wound infections.
- **Transmission**: A. baumannii spreads through contact with contaminated surfaces and medical equipment. It is known for its ability to survive on surfaces for extended periods.
- **Prevention and Control**: Measures include rigorous cleaning and disinfection protocols, strict hand hygiene, and isolation of infected patients. Antibiotic stewardship and surveillance are also important to manage and prevent the spread of A. baumannii.
### 3. Causes of Antibiotic Resistance
#### **1. Overuse of Antibiotics**
- **Inappropriate Prescriptions**: Antibiotics are often prescribed for viral infections, such as the common cold or flu, where they are ineffective. This misuse contributes to resistance.
- **Self-Medication**: Individuals taking antibiotics without a prescription or not completing the full course can lead to incomplete eradication of bacteria, promoting resistance.
#### **2. Misuse of Antibiotics**
- **Inadequate Dosing**: Taking antibiotics at incorrect doses or for insufficient durations can fail to kill bacteria completely, allowing resistant strains to survive and multiply.
- **Wrong Antibiotic Selection**: Using antibiotics that are not specifically targeted to the infecting bacteria can lead to resistance. Broad-spectrum antibiotics, which target a wide range of bacteria, can disrupt normal flora and promote the growth of resistant organisms.
#### **3. Poor Infection Control Practices**
- **Hygiene Issues**: Inadequate hand hygiene and improper use of personal protective equipment (PPE) in healthcare settings can facilitate the spread of resistant bacteria.
- **Environmental Contamination**: Failure to properly disinfect and clean surfaces and medical equipment can lead to the persistence of resistant bacteria in hospital environments.
#### **4. Inadequate Vaccination**
- **Preventive Measures**: Lack of vaccination against bacterial diseases can increase the incidence of infections, which in turn leads to higher antibiotic use and potential resistance.
- **Herd Immunity**: Incomplete vaccination coverage can lead to outbreaks of diseases, driving up the use of antibiotics and contributing to resistance.
#### **5. Agricultural Use of Antibiotics**
- **Livestock Treatment**: The use of antibiotics in agriculture, especially for growth promotion in livestock, can contribute to the development of resistant bacteria. These bacteria can then be transmitted to humans through the food chain or environmental contamination.
- **Antibiotic Residues**: Residues of antibiotics in food products can promote resistance in human populations, particularly if the antibiotics used are similar to those prescribed in medicine.
#### **6. Genetic Factors**
- **Resistance Genes**: Bacteria can acquire resistance genes through horizontal gene transfer, where genes are exchanged between bacteria. This can occur through plasmids, transposons, or integrons.
- **Mutation**: Spontaneous mutations in bacterial DNA can lead to resistance. These mutations can alter antibiotic targets or reduce drug uptake.
#### **7. Global Travel and Trade**
- **Spread of Resistance**: International travel and trade can facilitate the spread of resistant bacteria across borders. Infected individuals or contaminated products can introduce resistance to new regions.
- **Antibiotic Use in Low-Resource Settings**: In regions with limited access to healthcare and antibiotics, the misuse and overuse of available antibiotics can exacerbate resistance issues.
#### **8. Lack of New Antibiotics**
- **Research and Development**: The slow development of new antibiotics means that existing antibiotics are increasingly ineffective against resistant strains. The pharmaceutical industry has not kept pace with the growing threat of resistance due to economic and scientific challenges.
- **Antibiotic Stewardship**: Effective stewardship programs that promote the responsible use of antibiotics are critical but may be lacking in some healthcare settings, contributing to resistance.
### 4. Diagnosis of Resistant Strains
Diagnosing antibiotic-resistant strains involves identifying the presence of resistant bacteria and determining the most effective treatment options. Accurate and timely diagnosis is crucial for effective management and containment of infections caused by resistant strains. This process typically includes several key components:
#### **1. Clinical Assessment**
- **Symptom Evaluation**: The diagnosis begins with a thorough assessment of the patient's symptoms, medical history, and potential exposure to resistant infections. Symptoms alone may not confirm resistance but can guide further diagnostic testing.
- **Patient History**: Information about recent antibiotic use, travel history, and exposure to healthcare settings helps identify the likelihood of resistant infections and informs the selection of diagnostic tests.
#### **2. Laboratory Testing**
- **Culture and Sensitivity Testing**: A sample from the infected site (e.g., blood, urine, sputum) is cultured to grow bacteria in a laboratory. Once isolated, the bacteria are tested against various antibiotics to determine their susceptibility or resistance. This process is essential for identifying specific resistant strains and selecting appropriate treatments.
- **Antibiotic Susceptibility Testing**: Techniques such as disk diffusion (Kirby-Bauer test), broth microdilution, and E-test are used to assess bacterial susceptibility to antibiotics. The results indicate whether bacteria are sensitive, intermediate, or resistant to specific drugs.
#### **3. Molecular Methods**
- **Polymerase Chain Reaction (PCR)**: PCR is used to detect specific resistance genes within bacterial DNA. This method provides rapid and precise identification of genetic markers associated with resistance, such as those for methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE).
- **Genotypic Profiling**: Advanced molecular techniques, such as whole-genome sequencing and microarrays, are employed to analyze the genetic makeup of bacteria. These methods help identify mutations and resistance mechanisms, offering detailed insights into the resistance patterns of strains.
#### **4. Rapid Diagnostic Tests**
- **Point-of-Care Tests**: Rapid diagnostic tests, including molecular assays and immunoassays, provide quick results at the bedside or in outpatient settings. These tests help identify resistant strains and guide treatment decisions in a timely manner.
- **Bioinformatics Tools**: Bioinformatics approaches analyze data from various diagnostic tests to predict resistance patterns and recommend appropriate antibiotics. These tools integrate data from clinical, laboratory, and molecular sources to enhance diagnostic accuracy.
#### **5. Surveillance and Reporting**
- **Regional and National Surveillance**: Surveillance systems track the prevalence and spread of resistant strains across different regions. Reporting mechanisms help monitor trends, share data with public health authorities, and guide infection control strategies.
- **Resistance Databases**: Databases that compile information on resistance patterns and mechanisms support diagnostic efforts by providing reference data and facilitating comparison with known resistant strains.
#### **6. Challenges in Diagnosis**
- **Delayed Results**: Traditional culture methods may take several days to produce results, which can delay the initiation of effective treatment for resistant infections. Rapid diagnostic methods aim to address this issue but may not be available in all settings.
- **Limited Resources**: Access to advanced diagnostic technologies and expertise can be limited in some healthcare settings, affecting the timely identification of resistant strains. Efforts are needed to improve diagnostic infrastructure and capabilities, especially in low-resource areas.
### 5. Prevention and Control Measures
Preventing and controlling antibiotic-resistant strains requires a multifaceted approach involving healthcare practices, public health initiatives, and patient education. Effective strategies aim to reduce the emergence and spread of resistant bacteria, ensuring that antibiotics remain effective for treating infections. Key prevention and control measures include:
#### **1. Infection Control Practices**
- **Hand Hygiene**: Regular and thorough handwashing with soap and water or the use of alcohol-based hand sanitizers is crucial in preventing the transmission of resistant bacteria. Hand hygiene should be practiced by healthcare workers, patients, and visitors in healthcare settings.
- **Personal Protective Equipment (PPE)**: The use of PPE, such as gloves, gowns, and masks, helps prevent the spread of resistant bacteria. Proper use of PPE is essential during patient care, especially when dealing with infected or colonized individuals.
#### **2. Antimicrobial Stewardship**
- **Appropriate Use of Antibiotics**: Antibiotic stewardship programs promote the rational use of antibiotics by ensuring they are prescribed only when necessary and selecting the most appropriate antibiotic for the infection. This approach helps minimize the development of resistance.
- **Guidelines and Protocols**: Establishing and adhering to clinical guidelines and protocols for antibiotic use can reduce the likelihood of resistance. These guidelines are based on evidence-based practices and local resistance patterns.
#### **3. Infection Prevention Measures**
- **Vaccination**: Vaccines can prevent infections that might otherwise require antibiotic treatment. Immunization programs for vaccines against bacterial infections, such as pneumococcus and influenza, help reduce the need for antibiotics and limit the spread of resistant strains.
- **Environmental Cleaning**: Regular cleaning and disinfection of surfaces and equipment in healthcare settings help prevent the spread of resistant bacteria. Effective cleaning protocols reduce the risk of contamination and transmission.
#### **4. Surveillance and Monitoring**
- **Resistance Monitoring**: Monitoring and tracking antibiotic resistance patterns through surveillance programs help identify trends and emerging resistance. This data informs public health strategies and guides infection control measures.
- **Outbreak Investigation**: Rapid identification and investigation of outbreaks involving resistant strains allow for targeted interventions and containment efforts. Surveillance systems support timely response and management of outbreaks.
#### **5. Patient Education**
- **Education on Antibiotic Use**: Educating patients about the appropriate use of antibiotics and the dangers of self-medication or incomplete courses of treatment helps reduce antibiotic misuse and resistance. Awareness campaigns can also promote understanding of the importance of following prescribed treatments.
- **Infection Prevention Education**: Informing patients about basic infection prevention practices, such as hand hygiene and vaccination, empowers them to contribute to reducing the spread of resistant bacteria.
#### **6. Policy and Regulation**
- **Antibiotic Regulation**: Implementing regulations to control the sale and use of antibiotics, including restrictions on over-the-counter sales and veterinary use, helps reduce the misuse of antibiotics and the development of resistance.
- **Infection Control Policies**: Policies and regulations governing infection control practices in healthcare facilities support adherence to best practices and ensure a consistent approach to preventing and managing resistant infections.
#### **7. Global Collaboration**
- **International Cooperation**: Antibiotic resistance is a global issue that requires international collaboration and coordination. Countries and organizations work together to share information, resources, and strategies for combating resistance and promoting effective infection control.
#### **8. Research and Development**
- **New Antimicrobials and Alternatives**: Investment in research and development of new antibiotics, alternative therapies, and rapid diagnostic tests is crucial for staying ahead of resistance. Innovations in these areas help address the challenges posed by resistant strains and improve treatment options.
### 6. Treatment and Management
**Treatment and management** of antibiotic-resistant strains involve strategies that differ from those used for susceptible strains. Addressing infections caused by resistant bacteria requires a tailored approach, combining alternative therapies, patient care, and ongoing evaluation to ensure effective outcomes. Here are key components of treatment and management:
#### **1. Alternative Antibiotics**
- **Use of Last-Resort Antibiotics**: For infections caused by resistant strains, last-resort or "reserve" antibiotics, such as carbapenems, colistin, or tigecycline, may be used. These antibiotics are reserved for severe infections where other treatments have failed or are not suitable.
- **Combination Therapy**: Combining multiple antibiotics can enhance effectiveness against resistant strains. Combination therapy may include using drugs with different mechanisms of action to target the bacteria more effectively and prevent further resistance development.
#### **2. Tailored Treatment Plans**
- **Individualized Therapy**: Treatment plans should be tailored based on the specific strain of bacteria and its resistance profile. This approach involves performing susceptibility testing to determine which antibiotics are effective and adjusting therapy accordingly.
- **Clinical Decision Support**: Healthcare providers may use clinical decision support tools and guidelines to select the most appropriate treatment. These tools integrate data on resistance patterns and patient factors to guide therapeutic decisions.
#### **3. Rapid Diagnostic Testing**
- **Enhanced Diagnostics**: Rapid diagnostic tests are crucial for quickly identifying resistant strains and guiding appropriate treatment. Advanced molecular techniques, such as PCR (polymerase chain reaction) and whole-genome sequencing, help detect resistance genes and provide timely information for treatment decisions.
- **Surveillance Systems**: Ongoing surveillance of resistance patterns helps inform treatment decisions and adjust strategies based on current trends. Regular updates on resistance data support evidence-based management of infections.
#### **4. Supportive Care**
- **Symptomatic Relief**: In addition to antimicrobial therapy, supportive care measures are essential for managing symptoms and improving patient comfort. This may include pain management, fluid replacement, and other supportive interventions.
- **Monitoring and Follow-Up**: Close monitoring of patients during treatment helps assess the effectiveness of therapy and identify any adverse effects. Follow-up visits and tests ensure that the infection is responding to treatment and that no complications arise.
#### **5. Infection Control Measures**
- **Isolation Procedures**: Patients with infections caused by resistant strains may require isolation to prevent the spread of bacteria to other patients. Infection control measures, including contact precautions and isolation rooms, help manage the transmission of resistant organisms in healthcare settings.
- **Environmental Cleaning**: Regular cleaning and disinfection of patient areas and medical equipment are crucial to prevent the spread of resistant bacteria. Effective environmental cleaning protocols reduce the risk of contamination and transmission.
#### **6. Patient Education and Adherence**
- **Education on Treatment**: Educating patients about the importance of completing their prescribed treatment regimen and following medical advice helps ensure adherence and reduce the risk of treatment failure or resistance development.
- **Managing Side Effects**: Patients should be informed about potential side effects of their treatment and how to manage them. Clear communication between healthcare providers and patients enhances treatment adherence and overall management.
#### **7. Review and Adjustments**
- **Ongoing Assessment**: Regular review of treatment efficacy and patient progress is necessary to make adjustments if the initial therapy is not effective. Treatment plans may need to be modified based on patient response, changes in resistance patterns, or emerging evidence.
- **Adaptation to Resistance Trends**: As resistance patterns evolve, treatment strategies may need to be adapted. Staying informed about new developments in resistance and treatment options helps ensure effective management of resistant infections.
#### **8. Research and Development**
- **Novel Therapies**: Continued research into new antibiotics, alternative therapies, and innovative treatment approaches is essential for addressing resistant infections. Ongoing development of new drugs and therapies provides additional options for managing challenging cases.
- **Clinical Trials**: Participation in clinical trials for new treatments and therapies can contribute to advancing the management of resistant infections and improving patient outcomes.
### 7. Future Challenges and Research
**Future challenges and research** in the field of antibiotic resistance focus on overcoming the limitations of current treatments, developing new strategies, and enhancing our understanding of resistance mechanisms. Addressing these challenges is crucial for managing and eventually mitigating the impact of antibiotic-resistant strains. Key areas of focus include:
#### **1. Development of New Antibiotics**
- **Innovation in Drug Discovery**: Developing new antibiotics is a major challenge due to the complex nature of bacterial resistance mechanisms. Research is ongoing to discover novel compounds that can target resistant bacteria effectively. This includes exploring new drug classes, natural products, and synthetic compounds.
- **Overcoming Drug Resistance**: New antibiotics must be designed to evade or overcome existing resistance mechanisms. This involves understanding how bacteria develop resistance and designing drugs that can bypass or inhibit these mechanisms.
#### **2. Rapid Diagnostic Tools**
- **Advancing Diagnostic Technologies**: Rapid, accurate diagnostic tools are essential for identifying resistant strains quickly and guiding appropriate treatment. Research is focused on improving molecular diagnostic techniques, such as PCR and next-generation sequencing, to enhance their speed and accuracy.
- **Integration with Clinical Practice**: Ensuring that new diagnostic tools are integrated into clinical practice and widely available is critical. This involves overcoming barriers to implementation and ensuring that healthcare providers have access to these tools for effective patient management.
#### **3. Addressing Resistance Mechanisms**
- **Understanding Mechanisms**: Ongoing research aims to better understand the mechanisms through which bacteria develop resistance to antibiotics. This includes studying genetic, biochemical, and environmental factors that contribute to resistance.
- **Targeting Resistance Pathways**: Developing therapies that specifically target resistance mechanisms, such as resistance genes or efflux pumps, is a promising area of research. This approach aims to enhance the effectiveness of existing antibiotics.
#### **4. Stewardship and Policy Development**
- **Antibiotic Stewardship Programs**: Strengthening antibiotic stewardship programs to ensure the judicious use of antibiotics is crucial. Research is focused on developing effective stewardship strategies, guidelines, and policies to reduce inappropriate antibiotic use and slow the spread of resistance.
- **Global Health Policies**: Collaborative efforts to develop and implement global health policies aimed at combating antibiotic resistance are essential. This includes international cooperation to standardize practices and share data on resistance patterns.
#### **5. Infection Control and Prevention**
- **Improving Infection Control Practices**: Research into better infection control practices, including hygiene protocols, disinfection methods, and isolation procedures, is vital for preventing the spread of resistant bacteria.
- **Vaccine Development**: Developing vaccines against bacterial pathogens can reduce the need for antibiotics and help prevent infections caused by resistant strains. Research into new vaccine candidates and improving existing vaccines is a key focus.
#### **6. Understanding the Environmental Impact**
- **Environmental Reservoirs of Resistance**: Research is needed to understand how antibiotic resistance is transmitted through environmental reservoirs, such as soil, water, and agricultural practices. This includes studying the impact of antibiotic use in agriculture and its contribution to resistance.
- **Mitigating Environmental Contamination**: Strategies to mitigate environmental contamination with antibiotics and resistant bacteria are essential. This involves developing and implementing waste management practices and monitoring environmental impact.
#### **7. Public Awareness and Education**
- **Raising Awareness**: Increasing public awareness about the dangers of antibiotic resistance and the importance of responsible antibiotic use is crucial. Research into effective communication strategies and educational programs can help promote better practices among the general population.
- **Training Healthcare Providers**: Educating healthcare providers about the latest developments in resistance and treatment options is important for ensuring effective patient management and adherence to best practices.
#### **8. Global Collaboration and Research Initiatives**
- **International Research Collaborations**: Collaborative research efforts across countries and institutions can accelerate the development of new treatments and strategies. Global initiatives, such as the Global Antimicrobial Resistance Surveillance System (GLASS), facilitate the sharing of data and resources.
- **Funding and Support**: Securing funding for research into antibiotic resistance and new treatments is essential. Continued investment in research and development will support innovation and progress in combating resistance.
### 8. Conclusion
The rise of antibiotic-resistant bacterial strains poses a significant challenge to global health, demanding immediate and sustained action. As resistance continues to spread, it is essential to understand the underlying factors contributing to this issue, including the misuse and overuse of antibiotics, the mechanisms through which bacteria develop resistance, and the impact on healthcare systems.
**Understanding and Addressing Resistance:**
Antibiotic resistance arises from complex interactions between bacteria and antibiotics. By comprehending these mechanisms, including genetic mutations and the acquisition of resistance genes, researchers and healthcare providers can better target interventions and treatments. This understanding also highlights the need for stringent infection control practices and effective stewardship programs to curb the spread of resistant strains.
**Diagnostic and Management Challenges:**
Accurate and rapid diagnostic tools are critical for identifying resistant infections and guiding appropriate treatment. Advancements in diagnostic technologies and improved management strategies are essential for tackling the challenges presented by resistant bacteria. Ensuring that healthcare providers have access to these tools and strategies is crucial for effective patient care and containment of resistance.
**Future Directions and Research:**
The fight against antibiotic resistance requires ongoing research and innovation. Developing new antibiotics, enhancing diagnostic capabilities, understanding resistance mechanisms, and implementing robust infection control measures are key areas of focus. Additionally, global collaboration, public awareness, and policy development play vital roles in addressing the broader implications of resistance.
**Global Efforts and Prevention:**
Addressing antibiotic resistance is a global endeavor that requires coordinated efforts across countries and sectors. Implementing effective antibiotic stewardship, improving infection control practices, and investing in research are essential components of a comprehensive strategy. Public education and awareness initiatives also play a critical role in promoting responsible antibiotic use and reducing the risk of resistance.
**In Summary:**
Antibiotic-resistant bacterial strains present a pressing challenge that affects public health worldwide. Through a combination of research, innovation, policy, and global collaboration, it is possible to mitigate the impact of resistance and preserve the efficacy of antibiotics for future generations. Continued efforts to understand, manage, and prevent resistance are crucial for safeguarding global health and ensuring effective treatment options for bacterial infections.