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Antibiotic resistance in the hospital setting: extent of the problem and possible solutions.

The advent of effective antimicrobial agents has been justifiably hailed as one of the most significant medical advances. However, as experience with older agents has grown and as newer compounds have been added to the clinician's armamentarium, certain disadvantages associated with the use of antimicrobials have become increasingly apparent. Toxicity and cost are among the disadvantages, but drug resistance is probably the major adverse consequence of widespread antimicrobial use. This article reviews the extent, mechanisms, and consequences of antimicrobial resistance--particularly in the hospital environment--and offers strategies for minimizing both its emergence and its spread.