Dynamics of antimicrobial resistance between the hospital and the environment

Over the last 60 years, the widespread use of antibiotics and other substances with antimicrobial activity had inverted the natural equilibrium between fully susceptible and resistant bacteria. Gradually, antibiotic resistant bacteria and specific genetic determinants have reached new habitats, with evident increases on the prevalence of resistance and the extension of the spectrum of antimicrobial substances tolerated. Dramatic situations of both, high prevalence and multidrug resistance are reported mainly in the clinical environment.