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Optimism for identifying antimicrobial agents that would \u201csolve the problem\u201d of resistance has been replaced by a much more guarded and realistic view of the battle between humans and pathogenic microorganisms. Efforts now are more appropriately directed toward limiting, rather than completely eliminating, resistance, generally by either infection control or antibiotic control measures, and sometime combinations of the two. Methicillin\u2010oxacillin resistance in <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA) results from the expression of an acquired penicillin\u2010binding protein (PBP 2a) that is not transferable in vitro. In most hospitals, even those with high percentages of MRSA, relatively few resistant clones are identified, suggesting transmission of individual strains throughout the hospital population. Because person\u2010to\u2010person spread is so important in transmission of MRSA, strategies aimed at preventing transmission of the resistant strains are remarkably effective when strictly enforced. Ceftazidime resistance in Enterobacteriaceae results from point mutations within genes that encode widely prevalent and often transferable plasmid\u2010mediated enzymes. In addition, mutations of these genes that allow hydrolysis of cephalosporins usually result in decreased activity against other drugs, including the penicillins and \u03b2\u2010lactamase inhibitors. Effective measures to control ceftazidime\u2010resistant Enterobacteriaceae have as their cornerstone limiting administration of antibiotics that select for the emergence and spread of these mutations, especially ceftazidime. The importance of infection\u2010control techniques in limiting the prevalence of ceftazidime\u2010resistant Enterobacteriaceae is less well established. Methods that are informed by a detailed understanding of the molecular mechanisms of resistance and resistance spread offer the best hope for limiting dissemination of antibiotic\u2010resistant bacteria in a cost\u2010effective manner.<\/jats:p>","DOI":"10.1592\/phco.19.12.120s.31699","type":"journal-article","created":{"date-parts":[[2004,5,7]],"date-time":"2004-05-07T07:26:25Z","timestamp":1083914785000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Successful Interventions for Gram\u2010Negative Resistance to Extended\u2010Spectrum \u03b2\u2010Lactam Antibiotics"],"prefix":"10.1002","volume":"19","author":[{"given":"Louis 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