In the ICU, MRSA means we pull out vancomycin, ESBL pushes us to carbapenems, and carbapenem-resistance forces us to the last-line drugs like colistin. NDM-1 is the enzyme that dismantles carbapenems, and its spread has made some infections virtually untreatable, pushing colistin use so much that resistance to it is now our nightmare. What the textbooks call "antibiotic stewardship" feels like a luxury when you're watching a thirty-year-old with NDM-1 Klebsiella fade on the monitor, because the only thing left to steward is a prayer.
#ipl#dc
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