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Antibiotic resistance
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Abstract:
Antibiotics are commonly viewed as the most important advance in the history of medicine. During the six decades that followed the introduction of sulfonamides there has been a continuous supply of new agents responsive to evolving resistance of prior pathogens and emerging new pathogens. It now appears that the microbes confronting clinicians in the 1990s pose challenges that are unprecedented in the recent past. There are examples in virtually every category: malaria, multidrug-resistant Mycobacterium tuberculosis, multiply resistant gram-negative bacilli, azole-resistant Candida species, and metronidazole-resistant Trichomonas. The two pathogens that are arguably the most important to otolaryngologists are vancomycin-resistant Enterococcus faecium and penicillin-resistant Streptococcus pneumoniae. The former is a nosocomially acquired pathogen that is especially prevalent in intensive care units and usually cannot be treated with antibiotics that have established merit. Penicillin-resistant S pneumoniae is suddenly becoming a major problem in much of the world and its frequency in the United States is escalating at an alarming rate, especially in some geographic areas. This organism will require entirely new strategies for the empiric treatment of serious infections in which S pneumoniae is a documented or suspected pathogen. It is premature to say that traditional approaches to sinusitis and otitis need to be changed, but many suspect this will happen. One important lesson from this experience is that extensive antibiotic use and abuse has had some devastating consequences and many now believe that these are inevitable given current usage rates. The second lesson is that, although resistance seems predictable, specific patterns are not.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Antibiotic resistance is a growing global health crisis, with pathogens like penicillin-resistant Streptococcus pneumoniae posing unprecedented challenges. New treatment strategies are urgently needed to combat these evolving microbial threats.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antibiotics revolutionized medicine, but decades of use have led to widespread antimicrobial resistance.
- Emerging and re-emerging pathogens present significant challenges, including malaria, multidrug-resistant Mycobacterium tuberculosis, and resistant strains of Candida and Trichomonas.
- Nosocomial infections caused by vancomycin-resistant Enterococcus faecium and community-acquired infections by penicillin-resistant Streptococcus pneumoniae are major clinical concerns.
Purpose of the Study:
- To highlight the escalating threat of antimicrobial resistance in the 1990s.
- To identify key pathogens demonstrating resistance to established treatments.
- To underscore the need for novel therapeutic approaches in otolaryngology and beyond.
Main Methods:
- Review of current literature on antimicrobial resistance patterns.
- Identification of prevalent resistant pathogens in clinical settings.
- Analysis of the impact of antibiotic use and abuse on resistance.
Main Results:
- Significant increases in resistance observed across various pathogens, including gram-negative bacilli, Candida species, and Trichomonas vaginalis.
- Vancomycin-resistant Enterococcus faecium poses a significant threat in intensive care units.
- Penicillin-resistant Streptococcus pneumoniae is rapidly increasing globally and in the United States, necessitating new empiric treatment strategies.
Conclusions:
- Extensive antibiotic use and abuse have led to devastating consequences, with resistance appearing inevitable at current usage rates.
- While resistance patterns can be predicted to some extent, specific trends remain unpredictable.
- New strategies are required for treating serious infections caused by resistant pathogens, potentially altering traditional approaches to common conditions like sinusitis and otitis.