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Bacterial pathogens depend on precise and efficient DNA replication to sustain infection. Two type II topoisomerases—DNA gyrase and topoisomerase IV—are critical to this process, as they resolve DNA supercoiling and unlink chromosomes during replication. Fluoroquinolones, synthetic derivatives of quinolones, exploit this mechanism by stabilizing the transient DNA–enzyme cleavage complex, preventing strand religation, and causing lethal double-strand breaks. These antibiotics are selectively...
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Visualization of Bacterial Resistance using Fluorescent Antibiotic Probes
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Published on: March 2, 2020

Resistance surveillance studies: a multifaceted problem--the fluoroquinolone example.

A Dalhoff1

  • 1Institute for Infection-Medicine, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Str. 4, 24105, Kiel, Germany. adalhoff@t-online.de

Infection
|March 31, 2012
PubMed
Summary

Fluoroquinolone resistance is increasing globally in many bacteria, complicating treatment for infections like UTIs and respiratory illnesses. Surveillance studies, despite biases, are crucial for tracking resistance trends and guiding antimicrobial stewardship.

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Area of Science:

  • Microbiology and Infectious Diseases
  • Antimicrobial Resistance Epidemiology

Background:

  • This review synthesizes recent data on fluoroquinolone resistance epidemiology over the past five years.
  • Understanding resistance patterns is critical for effective antimicrobial therapy and public health.

Purpose of the Study:

  • To review and analyze current fluoroquinolone resistance trends.
  • To assess the impact of resistance on treatment guidelines and patient management.
  • To highlight limitations in current antimicrobial resistance surveillance methodologies.

Main Methods:

  • Systematic review of published fluoroquinolone resistance data from the last five years.
  • Stratification of data by prescription patterns (primary vs. tertiary care) and infection indication.
  • Analysis of resistance rates in various bacterial species, including Gram-positive, Gram-negative, and specific pathogens like Enterobacteriaceae, S. pneumoniae, and H. influenzae.

Main Results:

  • Fluoroquinolone resistance has increased in most bacterial species, particularly for healthcare-associated infections.
  • Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae show high rates of fluoroquinolone resistance, limiting treatment options.
  • Prevalence of QRDR mutations in H. influenzae and S. pneumoniae causing CARTIs indicates a risk for rapid resistance development.
  • Resistance has emerged in commensal flora, facilitating gene transfer and spread among pathogens.

Conclusions:

  • Despite inherent biases and inaccuracies in many surveillance studies, they provide vital insights into resistance trends.
  • The rise in fluoroquinolone resistance necessitates revisions in treatment guidelines and underscores the need for improved surveillance methods.
  • A global spread of resistance, similar to beta-lactam resistance in pneumococci, is a potential concern.