The clinical consequences of antimicrobial resistance
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1Medical Service 111(W), Louis Stokes Cleveland VA Medical Center, 10701 East Blvd., Cleveland, OH 44106, USA. louis.rice@va.gov
Abstract:
The continued evolution of antimicrobial resistance in the hospital and more recently in the community threatens to seriously compromise our ability to treat serious infections. The major success of the seven-valent Streptococcus pneumoniae vaccine at reducing both infection and resistance has been followed by the emergence of previously minor serotypes that express multiresistance. The almost universal activity of cephalosporins and fluoroquinolones against community Escherichia coli strains has been compromised by the spread of CTX-M beta-lactamase-producing, fluoroquinolone-resistant strains, and the emergence of community-onset methicillin-resistant Staphylococcus aureus, particularly in the United States, has forced us to re-think our empirical treatment guidelines for skin and soft-tissue infections. Finally, our most potent and reliable class of antibiotics, the carbapenems, is compromised by the growth, primarily in intensive care units, of multiresistant Klebsiella pneumoniae, Acinetobacter baumanni, and Pseudomonas aeruginosa. The lack of a robust pipeline of new agents, particularly against resistant Gram-negative bacteria, emphasizes the importance of optimizing our use of current antimicrobials and promoting strict adherence to established infection control practices.
Insights
Antimicrobial resistance is a growing threat, compromising treatments for serious infections. Optimizing current antibiotic use and infection control is crucial due to emerging resistant strains and a lack of new drugs.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Antimicrobial resistance (AMR) poses a significant global health threat, impacting both hospital and community settings.
- The emergence of multidrug-resistant (MDR) strains, including *Streptococcus pneumoniae*, *Escherichia coli*, *Staphylococcus aureus*, *Klebsiella pneumoniae*, *Acinetobacter baumannii*, and *Pseudomonas aeruginosa*, is escalating.
- Existing treatment guidelines and antibiotic efficacy are increasingly challenged by these resistant pathogens.
Purpose of the Study:
- To highlight the escalating threat of antimicrobial resistance in clinical settings.
- To underscore the impact of resistance on common and severe infections.
- To emphasize the urgent need for strategies to combat AMR.
Main Methods:
- Review of current literature and clinical observations regarding antimicrobial resistance trends.
- Analysis of the impact of resistance on the effectiveness of key antibiotic classes (e.g., cephalosporins, fluoroquinolones, carbapenems).
- Examination of the emergence patterns of specific resistant organisms in hospital and community environments.
Main Results:
- Vaccine success against *Streptococcus pneumoniae* has been followed by the rise of MDR serotypes.
- Community *Escherichia coli* resistance to cephalosporins and fluoroquinolones is increasing due to CTX-M beta-lactamases.
- Community-onset methicillin-resistant *Staphylococcus aureus* (CA-MRSA) is altering treatment strategies for skin infections.
- MDR *Klebsiella pneumoniae*, *Acinetobacter baumannii*, and *Pseudomonas aeruginosa* are compromising carbapenem effectiveness, particularly in ICUs.
Conclusions:
- The pipeline for new antimicrobial agents, especially against Gram-negative bacteria, is insufficient.
- Optimizing the use of existing antimicrobials is essential.
- Strict adherence to infection control practices is paramount in mitigating the spread of AMR.
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