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The Journal of Bone and Joint Surgery (American) 83:1891-1901 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Antimicrobial Resistance: Guidelines for the Practicing Orthopaedic Surgeon

Douglas R. Osmon, MD, MPH

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

Douglas R. Osmon, MD, MPH
Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, 200 First Street S.W., Rochester, MN 55905.

The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy’s Annual Meeting, will be available in March 2002 in Instructional Course Lectures, Volume 51. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).


   Introduction
 
Antimicrobial resistance among pathogens, such as Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and aerobic gram-negative bacilli, is pervasive in the community and hospital setting. Every practicing orthopaedist faces on a daily basis the increasing problem of antimicrobial resistance in the effort to prevent or treat nosocomial infections. Recognizing the scope of the problem; understanding the mechanisms of antimicrobial resistance as well as the epidemiology, prevention, and treatment of infections due to resistant organisms; and knowing the proposed solutions to these problems will optimize the orthopaedic surgeon’s ability to manage multidrug-resistant nosocomial pathogens.


   Scope and Mechanisms of Antimicrobial Resistance
 
In 1990, the National Foundation for Infectious Diseases stated that the estimated cost of nosocomial infections due to antimicrobial-resistant pathogens in the United States was as high as $4 billion annually and that antimicrobial resistance and emerging infections were the most important problems in the prevention and control of infectious diseases1,2. In 1995, in New York City alone, . . . [Full Text of this Article]


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