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DAVID S. BURGESS, PHARM.D., FCCP, is Clinical Professor of Pharmacy and Medicine, College of Pharmacy, The University of Texas at Austin and The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, 7703 Floyd Curl Drive - MSC 6220, San Antonio, TX 78229-3900 (burgessd{at}uthscsa.edu), and ROBERT P. RAPP, PHARM.D., FCCP, Professor of Pharmacy, College of Pharmacy, University of Kentucky Medical Center, C-114D Chandler Medical Center, University of Kentucky, Lexington, KY 40536 (rprapp01{at}email.uky.edu).

Purpose. To address how the high endemic levels of antimicrobial resistance and multidrug resistance in hospitals have challenged clinicians to select appropriate therapy for effectively treating bacterial infections among seriously ill patients. Summary. Among gram-positive bacterial infections, differentiating between healthcare-associated and community-associated methicillin-resistant Staphylococcus aureus infections is becoming more difficult and can seriously impact therapeutic strategies and hence outcomes. Furthermore, the rising prevalence of multidrug-resistant gram-negative bacterial infections is increasing the pressure on proper antimicrobial selection given the dearth of new antimicrobial agents under development. Optimized dosing strategies will be instrumental in minimizing emergence of resistance and preserving the utility of currently available agents. Antimicrobial stewardship programs in conjunction with stringent infection control policies will be critical in improving the appropriate use of antimicrobials while reducing the spread of nosocomial pathogens. Conclusion. Addressing the challenges of antimicrobial resistance in hospitals will require a multidisciplinary approach, with clinical pharmacists taking a proactive role in ensuring the appropriate use of antimicrobials. Index terms: Antiinfective agents; Bacterial infections; Clinical pharmacists; Drug use; Drugs; Hospitals; Protocols; Rational therapy; Resistance; Team