The WHO has recognised antibiotic resistance as one of the greatest threats to human health. As a microbiologist, antibiotic resistance is a problem that keeps me awake at night and inevitably the impact of antibiotic resistance on paediatricians is a matter of when, and not if. I fear for the future of paediatric services such as neonatology, oncology and elective surgery. A recent US study found that 26.8% of post chemotherapy infections and 38.7–50.9% of post-operative infections were caused by bacteria resistant to standard antibiotic prophylaxis. The authors predicted that this will lead to an additional 6300 infection-related deaths in the USA each year. Closer to home, David Cameron commissioned a review into antimicrobial resistance in 2014 and the findings were extremely worrying. The report predicted that by 2050, 10 million annual worldwide deaths will be attributable to antimicrobial resistance. More than annual predicted cancer-associated and diabetes-associated mortality combined. The golden antibiotic era is certainly over. Selecting the most appropriate antibiotic to treat an infection depends on many factors, including route of administration, penetration to site of infection and pathogen susceptibility. Most clinicians do not need an in-depth understanding of bacterial resistance mechanisms as local microbiologists can provide expertise and advice. However, in an era of increasing antibiotic resistance, an insight into the organism factors that affect antibiotic selection can prove useful.
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