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Why do antimicrobial agents become ineffectual?
1Department of Microbiology, School of Medicine, Kitasato University, Japan. matsu@kitasato-u.ac.jp
Abstract:
Antibiotic resistance has evolved over the past 50 years from a merely microbiological curiosity to a serious medical problem in hospitals all over the world. Resistance has been reported in almost all species of gram-positive and -negative bacteria to various classes of antibiotics including recently developed ones. Bacteria acquire resistance by reducing permeability and intracellular accumulation, by alteration of targets of antibiotic action, and by enzymatic modification of antibiotics. Inappropriate use of an antibiotic selects resistant strains much more frequently. Once resistant bacteria has emerged, the resistance can be transferred to other bacteria by various mechanisms, resulting in multiresistant strains. MRSA is one of the typical multiresistant nosocomial pathogens. A study of the PFGE pattern of endonuclease-digested chromosomal DNA showed that MRSA of a few clones were disseminated among newborns in the NICU of a Japanese hospital. In this regard, it is important to choose appropriate antibiotics and then after some time, to change to other classes to reduce the selection of resistant strains. Since the development of epoch-making new antibiotics is not expected in the near future, it has become very important to use existing antibiotics prudently based on mechanisms of antibiotic action and bacterial resistance. Control of nosocomial infection is also very important to reduce further spread of resistant bacteria.
Insights
Antibiotic resistance is a growing global health threat, driven by bacterial evolution and inappropriate antibiotic use. Prudent antibiotic selection and infection control are crucial to combat resistant strains like MRSA.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic resistance has escalated from a microbiological issue to a significant global healthcare challenge.
- Resistance is observed across diverse bacterial species and antibiotic classes, including newer agents.
- Mechanisms of resistance include reduced drug permeability, altered antibiotic targets, and enzymatic inactivation.
Purpose of the Study:
- To review the evolution and mechanisms of antibiotic resistance.
- To highlight the role of inappropriate antibiotic use in selecting resistant strains.
- To emphasize strategies for controlling the spread of antibiotic-resistant bacteria in healthcare settings.
Main Methods:
- Review of existing literature on antibiotic resistance mechanisms and epidemiology.
- Analysis of bacterial resistance acquisition and transfer mechanisms.
- Case study of Methicillin-resistant Staphylococcus aureus (MRSA) dissemination in a Neonatal Intensive Care Unit (NICU) using Pulsed-Field Gel Electrophoresis (PFGE).
Main Results:
- Inappropriate antibiotic use significantly accelerates the selection and proliferation of resistant bacterial strains.
- Bacterial resistance can be transferred between bacteria, leading to the emergence of multidrug-resistant organisms (MDROs).
- PFGE analysis revealed the clonal dissemination of MRSA among neonates in a Japanese NICU, underscoring the threat of nosocomial infections.
Conclusions:
- Judicious use of existing antibiotics, informed by their mechanisms of action and bacterial resistance patterns, is paramount.
- Developing new antibiotics is unlikely in the near future, necessitating conservative antibiotic stewardship.
- Effective control of nosocomial infections is essential to curb the spread of antibiotic-resistant bacteria.