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Fourteen years in resistance
1Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. d.livermore@uea.ac.uk
International Journal of Antimicrobial Agents
|March 6, 2012
Summary
Antibiotic resistance trends show declining Gram-positive infections like MRSA and pneumococci, but worsening Gram-negative resistance, particularly in Enterobacteriaceae and Acinetobacter. Global shifts and industry changes pose future challenges.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Over 14 years (1997-2011), significant shifts in antibiotic resistance trends were observed.
- Improvements in infection control and vaccine deployment impacted resistance patterns for Gram-positive pathogens.
- Emergence and spread of multidrug-resistant Gram-negative bacteria present a growing concern.
Purpose of the Study:
- To analyze the changing landscape of antibiotic resistance trends in the UK.
- To evaluate the impact of interventions, laboratory advancements, and global factors on resistance.
- To identify future challenges for antibiotic chemotherapy and modern medicine.
Main Methods:
- Longitudinal analysis of antibiotic resistance data from 1997-2011.
- Monitoring of key pathogens including meticillin-resistant Staphylococcus aureus (MRSA), resistant pneumococci, Enterobacteriaceae, Acinetobacter, and gonococci.
- Assessment of changes in laboratory practices, clinical guidelines, and the pharmaceutical industry.
Main Results:
- Meticillin-resistant Staphylococcus aureus (MRSA) and resistant pneumococci showed declines.
- Significant increases in resistance were noted for Gram-negative bacteria, including quinolone- and cephalosporin-resistant Enterobacteriaceae, carbapenemase-producing Acinetobacter and Enterobacteriaceae, and fluoroquinolone/cefixime-resistant gonococci.
- Laboratory testing improved in standardization but not speed; pharmacodynamic breakpoints added scientific rigor but led to some dosing issues.
Conclusions:
- While Gram-positive resistance has improved, Gram-negative resistance poses a severe and escalating threat.
- Changes in the pharmaceutical industry and global health dynamics, particularly the rise of India and China, present complex challenges.
- The future of antibiotic chemotherapy and modern medicine is threatened by these evolving resistance patterns and global factors.
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