Microbiology and drug resistance mechanisms of fully resistant pathogens
Introduction
Antibiotic resistance is reaching a crisis because we are running out of options to treat certain pathogenic bacteria, mainly causing hospital-acquired infection but with the potential to occur in the community. These multi-resistant bacteria are generally identified by the acquisition of specific resistance genes that are catastrophic. The development of these resistant strains has built up progressively over the past 20 years but has come to a head within the past five. Although there were incidences of outbreaks of multi-resistant bacteria in the past 10 years, these are now becoming more frequent and more persistent. The incidence of resistant bacteria used to fall back a little after intervention but now this occurs less readily, largely because we do not have effective antibiotics to treat them. The extrapolation of fewer periods of remission from multi-drug resistance is, of course, that these bacteria progress to pan-resistance where no class of antibiotics can be used effectively to treat them. This is the situation we are beginning to experience in some clinical bacteria.
In this review, we focus on those bacteria where pan-resistance has been or is set to be a problem.
Section snippets
Hospital-acquired infections
Some hospital-acquired pathogens are becoming totally resistant to antibiotics, known examples include vancomycin-resistant Enterococcus faecium and faecalis (VRE), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa [1]. The failure is often attributed to the misuse of antibiotics but the truth is probably that medicine has moved on and too much is now expected from antibiotics especially in the treatment of the
Conclusions
Antibiotic resistance in these pathogens is set to change the way we view medicine; elective surgery with the risk of an untreatable infection is an unattractive option and transplantation with the likelihood that any infection may lead inevitably to death is a gamble that many may not be prepared to take. However, total resistance in the community is likely to have a more immediate impact on the way we live, few parents would be prepared to send their children to day-care centres if the danger
References and recommended reading
Papers of particular interest, published within the annual period of review, have been highlighted as:
• of special interest
•• of outstanding interest
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