In terms of pathophysiology, antibiotic resistance (AR) occurs when a microorganism develops a genetic mutation that enables the organism to withstand antimicrobial agents; this resistance can be exchanged between bacteria thereby disseminating this feature and extending its influence (Barie, 2012). When a microorganism carries more than one resistance gene – that is, different genes against different antimicrobial agents – it is referred to as multi-drug resistant or MDR (Barie, 2012). The mutation that gives rise to this resistance is often the result of the SOS response, an intense state of DNA repair and mutagenesis; this response is often induced by pharmacological antimicrobial agents such as ciprofloxican (Bos et al., 2015). Health determinants related to AR involve frequent infection requiring frequent antimicrobial treatments which enable the microorganisms to develop resistance or failure to complete antibiotic regimens (Barie, 2012). In terms of genomics, microorganisms which have been frequently exposed to antimicrobial agents and therefore forced into the SOS response are more likely to develop genetic mutations which will give rise to resistance (Barie, 2012; Bos et al., 2015). Epidemiologically speaking, such microorganisms used to be almost entirely found in hospitals but vulnerable populations (Barie, 2012). Therefore, there are several factors which can factor into AR. Certain populations are at increased risk for AR, including the elderly and surgical patients (Edmiston & Spencer, 2014). Evidence suggests that there are several evidence-based practices (EBP) that can be employed to reduce the risk of AR including hand hygiene, the use of antimicrobial sutures in surgical sites, preadmission showers and cleansing, and careful surveillance of at-risk populations (Edminston & Spencer, 2014). As a clinical nurse leader (CNL) I would foster the application of hand hygiene protocols, preadmission showers and cleansing, and careful surveillance of at-risk patients.

References
• Barie, P. S. (2012). Multidrug-resistant organisms and antibiotic management. Surgical Clinics of North America, 92(Management of Peri-operative Complications), 345-391. doi:10.1016/j.suc.2012.01.015
• Bos, J., Qiucen, Z., Vyawahare, S., Rogers, E., Rosenberg, S. M., & Austin, R. H. (2015). Emergence of antibiotic resistance from multinucleated bacterial filaments. Proceedings of the National Academy of Sciences of the United States of America, 112(1), 178-183. doi:10.1073/pnas.1420702111
• Edmiston Jr, C. E., & Spencer, M. (2014). Patient care interventions to help reduce the risk of surgical site infections. AORN Journal, 100(6), 590-602. doi:10.1016/j.aorn.2014.10.008