Wake up South Africa! The antibiotic 'horse' has bolted

Decades of poor medical and veterinary antibiotic prescribing and a lack of regard for the practice of infection prevention and control (IPC) in our hospitals have left South Africa, like the rest of the international community, on the brink of a return to an era of untreatable bacterial infection. The recent emergence in South Africa of bacteria carrying the highly mobile New Delhi metallo-β-lactamase-1 (NDM-1) gene, which has been associated with rapid spread of carbapenem-resistant Enterobacteriaceae (CRE), and, for the first time in Africa, Klebsiella pneumoniae carbapenemases (KPCs), will have a profound effect on the lives of our patients and on the health service. The acquisition of drug-resistant hospital-acquired infections (HAIs) increases morbidity, mortality and the cost of patient management to an already beleaguered health system by increasing the duration of hospital stay, often in expensive intensive care units (ICUs), and antibiotic prescribing costs.