Antimicrobial resistance and strategies for management and prevention, including antimicrobial stewardship

How resistance arises

Antimicrobial resistance arises through selection pressure from antimicrobial use, acting on existing or newly acquired resistance mechanisms (efflux pumps, target modification, enzymatic drug inactivation, reduced permeability) - antimicrobial stewardship (optimising use to minimise unnecessary selection pressure) is the primary prevention strategy alongside infection control (limiting spread of resistant organisms)
Resistance genes can be intrinsic (naturally present) or acquired (mutation, or horizontal transfer via plasmids/transposons between bacteria, including across species) - horizontal transfer explains how resistance can spread rapidly through a bacterial population independent of exposure to the specific selecting antibiotic in every individual organism

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