[The rise of resistant gram-negative bacteria]

During the past few years there has been a global spread of resistant gram-negative bacteria that are insensitive to cephalosporins and carbapenems. Extended spectrum beta-lactamase (ESBL)-producing bacteria are capable of inactivating the newest generation of cephalosporins. It is notable that ESBL-producing bacteria are found predominantly outside the hospital situation in the environment, in food and in meat products, which leads to the presumption that the food chain is contributing to the rapid spread of these bacteria. Several types of carbapenemase-producing bacteria have been distinguished, of which the 'New Delhi metallo beta-lactamase 1 (NDM-1)' type seems to be prevalent in Asia outside the hospital situation in the community, and is now being transmitted to other continents as a result of migration and tourism. With the rise of ESBL- and carbapenemase-producing gram-negative bacteria (which are also often resistant to most other antibiotics) comes the very real concern that treatment of infections such as urinary tract infections that are currently simple to treat with common oral antibiotics will be problematic in the future. The widespread use of antibiotics in animal husbandry is an important factor in the problem of antibiotic resistance. Since economic motives are of importance, a coordinated approach from many parties concerned will be necessary, not just from the medical sector but also from the veterinary and agricultural world, and from food producers and pharmaceutical companies to combat the spread of multiresistant gram-negative bacteria effectively.