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The zeitgeist of resistance

David Livermore1

  • 1Antibiotic Resistance Monitoring and Reference Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK. david.livermore@hpa.org.uk

The Journal of Antimicrobial Chemotherapy
|September 14, 2007
PubMed

Insights

Bacterial antibiotic resistance evolves continuously, with some resistances like methicillin-resistant Staphylococcus aureus stabilizing while others, such as cephalosporin and carbapenem resistance, rapidly increase. Successful resistance requires low fitness burden and a fit host, making control difficult.

Area of Science:

  • Microbiology
  • Evolutionary Biology
  • Infectious Diseases

Background:

  • Bacterial antibiotic resistance poses a significant global health threat, impacting infection treatment efficacy.
  • Antibiotic resistance mechanisms and prevalence are dynamic, influenced by evolutionary pressures.
  • Specific resistant strains like methicillin-resistant Staphylococcus aureus (MRSA) show varied prevalence globally.

Purpose of the Study:

  • To analyze the evolutionary patterns and mechanisms of bacterial antibiotic resistance.
  • To identify factors contributing to the success or failure of antibiotic resistance accumulation in bacterial populations.
  • To understand the implications of evolving resistance for clinical treatment strategies.

Main Methods:

  • Observational analysis of resistance prevalence data.
  • Review of documented mechanisms of antibiotic resistance.
  • Comparative analysis of successful versus unsuccessful resistance evolution in key bacterial pathogens.

Main Results:

  • While methicillin-resistant Staphylococcus aureus (MRSA) prevalence has stabilized in the UK, resistance to cephalosporins and quinolones in Gram-negative bacteria is increasing rapidly.
  • Carbapenem resistance is also growing, particularly in Acinetobacter species.
  • Highly feared resistances, such as vancomycin resistance in staphylococci, have not accumulated significantly despite emergence.

Conclusions:

  • The success of a bacterial antibiotic resistance mechanism depends on a low fitness cost to the host bacterium.
  • A combination of a low-fitness-burden mechanism and a biologically fit host strain is critical for resistance proliferation.
  • Once established, antibiotic resistance with these characteristics becomes extremely challenging to control.

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