Aminoglycoside resistance: a worldwide perspective.

Area of Science:

• Pharmacology
• Infectious Diseases
• Microbiology

Background:

• Aminoglycosides face reluctance in use due to toxicity concerns, especially in patients with renal impairment or on nephrotoxic drugs.
• A significant concern is the potential for widespread aminoglycoside use, particularly newer, more resistant compounds, to drive microbial resistance.

Purpose of the Study:

• To evaluate the actual impact of aminoglycoside use on the emergence of microbial resistance.
• To compare resistance patterns of aminoglycosides with other antibiotic classes, such as beta-lactams.

Main Methods:

• Review of surveillance studies and clinical trials assessing aminoglycoside resistance.
• Comparison of susceptibility data over time and across different patient populations.
• Analysis of factors contributing to aminoglycoside resistance, including drug exposure and usage patterns.

Main Results:

• Surveillance studies show modest reductions in aminoglycoside resistance even with amikacin use.
• Susceptibility to amikacin has remained stable over a decade in some institutions.
• Controlled trials, especially in immunocompromised patients, show low emergence of resistance, contrasting with some beta-lactam monotherapy studies.

Conclusions:

• The emergence of aminoglycoside resistance is complex and context-dependent, not solely driven by widespread use.
• Topical use or environmental contamination may contribute more significantly to resistance than therapeutic use.
• Further investigation into total drug exposure is needed; focus may be warranted on restricting widely used beta-lactams if resistance is a primary concern.