This nebulously fluffy topic ("implications of antimicrobial resistance") is presented in the otherwise pragmatic Required Reading section simply because it has previously appeared in a college paper (Question 14 from the second paper of 2000). More recently, Question 26 from the second paper of 2017 asked the candidates something a little more sensible ("discuss strategies to limit antimicrobial resistance").

One's ability to quickly answer such a broad question would be dependent on the preparation of a prefabricated rant, loaded and ready to launch at the examiners. In order for the candidates to prefabricate such a rant, the following summary is offered. It is based on a series of interesting articles, indepth familiarity with which is not mandatory.

In point form:

Implications for bedside practice

Prevention of resistance development

• Use of some antibiotics should be restricted/reserved
  • Use in agriculture and animal husbandry needs to be limited
• Broad spectrum antibiotics must be deployed intelligently
  • Rapid diagnostic methods to guide rapid de-escalation
• Antibiotics must be reviewed daily, and narrowed or discontinued when appropriate
• Infectious diseases physicians should have greater input into prescribing practices
• Perioperative prophylaxis needs to be rationalised
• Antibiotic cycling may be helpful in preventing the emergeance of resistant strains
• Combination therapy may be relevant to some species (eg. rifampicin plus fusidic acid, rather than either one as a sole agent).
• Selective digestive tract decontamination could potentially be useful
• Scrupulous attention to source control (i.e. do not use antibotics as a substitute for source control)

Prevention of MRO transmission:

• Routine barrier and infection control process needs complicance monitoring and regular review.
• Surveillance for MROs must be proactive.
• Patient isolation should be practiced
• Decolonisation may be used in certain circumstances

Prevention of clinically relevant MRO infections in colonised patients

• Careful monitoring of indwelling devices
• Vaccinations

Management of MRO infections

• Multi-drug cocktails might be helpful
• Use of a higher concentration of a drug may defeat resistance 
• MIC monitoring may guide dosing
• New drugs may need to be developed
• Novel drug combinations (eg. minocycline with loperamide) which exploit a synergy between antibiotics and non-antibiotic drugs
• Non-drug (eg. bacteriophage, immunoglobulin, hyperbaric oxygen) therapy may become necessary

Implications for critical care service provision

Increasing healthcare costs

• Increased cost of increased surveillance
• Increased cost of extended spectrum susceptibility testing
• Increased cost of increased use of consumables (eg. gloves, gowns, single room terminal cleaning)
• Increased cost of exotic antibiotics
• Increased cost of increased duration of hospital and ICU stay
• Increased cost of infectious disease staff (more man-hours required)

Implications for research

• Increased cost of developing and testing new antimicrobial agents
• Decreased interest in antibiotic research (a trend lasting many deceades)
• Research into non-antimicrobial strategies of infectious diseases management, such as
  • Immunomodulatory therapies
  • Therapies aimed at blocking access to host resources
  • Antiinflammatory therapies
  • Probiotics to compete with hostile bacterial growth
  • Bacteriophage therapy