After more than 7 decades of antibiotic use, a recurrent pattern of antimicrobial resistance spread is evident among certain bacterial pathogens. In this pattern, resistance occurs first among the most severely ill hospitalized patients, then spreads to involve other patients in the hospital, and ultimately reaches the community. These events are initially localized geographically; however, via spread from region to region, resistant bacterial strains eventually establish global endemicity. This pattern has been observed with penicillin-resistant staphylococci, methicillin-resistant Staphylococcus aureus (MRSA),1 and extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae.2 In each case, adequate preventive measures to contain the spread of resistant pathogens were not implemented in time. In this Commentary, we discuss the implications of a new resistance threat to public health: the global spread of carbapenem-resistant Enterobacteriaceae (CRE).
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