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The zeitgeist of resistance
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
Summary
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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