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Fourteen years in resistance

David M Livermore1

  • 1Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. d.livermore@uea.ac.uk

International Journal of Antimicrobial Agents
|March 6, 2012
PubMed

Insights

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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