It is both a cliché and a truism to state that antibiotic resistance has been around for as long as antibiotics have been used to treat infection. Indeed, the origin of antibiotic resistance extends much further back in evolutionary terms and reflects the attack and counter-attack of complex microbial flora in order to establish ecological niches and survive.
BACTERIAL
RESISTANCE TO ANTIBIOTICS
INTRODUCTION
It is both a cliché and a truism to
state that antibiotic resistance has been around for as long as antibiotics have
been used to treat infection. Indeed, the origin of antibiotic resistance
extends much further back in evolutionary terms and reflects the attack and
counter-attack of complex microbial flora in order to establish ecological
niches and survive. It is true to say that early treatment failures with
antibiotics did not represent a significant clinical problem because other
classes of agents, with different cellular targets, were available. It is the
emergence of multiple resistance, i.e. resistance to several types of
antibiotic agent, that is causing major problems in the clinic today. Several
factors drove this situation in the 1970s and 1980s, including the introduction
of extended-spectrum agents and advances in medical techniques, such as organ
transplantation and cancer chemotherapy. The net result has been a huge
selective pressure in favour of multiply resistant species. Coupled with this, there
has been a sharp decline in the introduction of agents acting on new cellular
targets over the last 30 years compared with the 20-year period following the
Second World War. There are a number of resistant organisms causing concern at
present. Notable Gram-positive organisms include meticillin-resistant Staphylococcus aureus (MRSA) and
coagulase-negative staphylococci, glycopeptide-intermediate sensitivity Staphylococcus aureus (GISA), vancomycin-resistant Enterococcus (VRE) species and penicillin-resistant Streptococcus pneumoniae. Concerns among the
Gram-negative organisms include multidrug-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia and
Acinetobacter baumannii and members of the Enterobacteriaceae
with extended-spectrum β-lactamases. Multidrug resistance in the acid-fast
bacilli Mycobacterium tuberculosis and M. avium complex pose major health threats
worldwide.
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