The Perpetual Challenge of Antimicrobial Resistance

Abstract

The emergence of multidrug-resistant bacteria and the rapid global spread of carbapenem-resistant Enterobacteriaceae (CRE) have recently captured public attention, and some have asked whether the ongoing public health and scientific "war" against drug-resistant microbes, particularly bacteria, can ever be won. In fact, the challenge of antimicrobial resistance is an enduring threat that likely will never be eliminated. The threat is due, in part, to the inherent ability of microbes to replicate rapidly and mutate, offering them an evolutionary advantage in fending off hazards to their survival. Addressing the threat of antimicrobial resistance is a never-ending challenge.The persistent nature of the struggle should come as no surprise. Although antimicrobial resistance has been inexorably linked to antibiotic use since the discovery of penicillin in 1928, resistance mutations occur even without the evolutionary pressure of antibiotics. In this regard, studies of bacteria in permafrost samples documented the existence of resistance genes 30 000 years ago. 1 Thus, antibiotics did not create the problem of antimicrobial resistance in isolation; however, their use, and misuse, exacerbates it. Clinicians clearly play a role, when nearly three-quarters of adults presenting for care in the United States with acute bronchitis (generally of viral etiology) receive an unnecessary antibiotic. The agricultural sector also may contribute to the problem, as veterinary use represents about three-quarters of the antibiotic market in the United States. The majority of this use is for the promotion of animal growth, with subtherapeutic doses that can foster resistance. These problems are not unique to the United States, as countries in Europe and elsewhere have faced similar challenges in their agricultural and human health care sectors. In developing countries, the challenges are compounded by limited capacity for surveillance and poorly regulated sales.These and other factors have combined to create a global crisis. In the United States alone, an estimated 23 000 deaths each year are associated with drugresistant bacterial infections. 2 The drug-resistant infections cost the US health care system an estimated $20 billion annually, with an additional estimated $35 billion in lost productivity. 2 Methicillin-resistant Staphylococcus aureus is pervasive, found in approximately 50% of isolates in acute care hospitals in the United States. 3 New strains of CRE rapidly spread in the United States from 1 to 44 states just in the last decade. More than half of bacterial isolates from urine samples from antenatal clinics in India showed resistance to commonly used antibiotics. This crisis is compounded by dwindling therapeutic options; although 16 antibiotics were approved by the US Food and Drug Administration between 1983 and 1987, only 2 were approved between 2008and 2012

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care

“…Antibiotic prescription in primary care is rising progressively again, and has now exceeded the peak in the late 1990s, further driving the development of antibiotic resistance, which may lead to serious infections becoming untreatable. 47,50 The high prevalence of OME, and the fact that it is estimated that one-third of all cases of otitis media are primarily OME related, 2,12 means that estimated rates of 80% antibiotic prescribing for all types of otitis media episodes in primary care are potentially reducible by a further 20-30%. 12 Finding an appropriate, feasible and low-cost management option for primary care for the majority of affected children must therefore be seen as an urgent priority, with the status quo of 'watch and wait' sometimes interpreted by parents as 'doing nothing' or as a form of demand suppression.…”

“…Unnecessary use of antibiotics also promotes the development of antibiotic resistance and the medicalisation of minor illness. [45][46][47][48][49][50] A few uncertainties remain for targeted, well-considered and selective use of antibiotics. 46 Speculatively, this may include secondary care subgroups as an alternative to surgery, or for any antibiotic-sensitive biofilm infection, or where recurrent acute otitis media (AOM) rather than OME is deemed to be the predominant underlying pathology.…”

Antibacterial, antioxidant and anti-proliferative properties and zinc content of five south Portugal herbs

“…From simple infusions to alleviate stomach problems to direct application on the skin to treat wounds, animal bites or other ailments, plants have had an important role in human history. When the modern times arrived, however, the attention turned to the use of synthetic drugs or other chemical substances in high amounts which in part led to bacteria resistance and weak immune system (Fair & Tor 2014;Fauci & Marston 2014). Nowadays the focus is shifting again, this time from synthetic to the natural agents, with a great interest in antioxidant, antibacterial and anti-carcinogenic properties of plants and their extracts.…”

Negatively Charged Lipids as a Potential Target for New Amphiphilic Aminoglycoside Antibiotics

“…Multidrug-resistant microbial pathogens (1,2) have become a worldwide problem that threatens the efficacy of many drugs commonly used to treat patients suffering from severe infections. Approximately 10% of all hospital-acquired infections are the results of Pseudomonas aeruginosa infections, a Gram-negative, opportunistic human pathogen.…”