Bacterial Resistance to Antibiotics - Introduction

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Chapter: Pharmaceutical Microbiology : Bacterial Resistance To Antibiotics

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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