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The emergence of antibiotic resistance: Myths and facts in clinical practice

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Abstract

Selection pressure, caused by the use of antibiotics — especially in hospitals — is the main factor responsible for the emergence of antibiotic-resistant bacteria. Resistance can arise endogenously by mutation (onestep, as found forMycobacterium tuberculosis to rifampicin, or multi-step, as in gonococci to benzylpenicillin), or exogenously by transfer of R-factors. Mechanisms of resistance may involve a decrease in permeability, chemical modification of the antibiotic, or a change in the affinity of the target site. There are many misconceptions concerning the incidence, nature and spread of antibiotic resistance, and some of the most important of these are discussed. The emergence and spread of resistance can be controlled by adhering to antibiotic policies and by preventing or controlling outbreaks of infection. The importance of resistant organisms can be diminished by the development of new antibiotic agents, preferably containing new chemical entities.

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References

  1. Davies J (1989) The new quinolones. Back to the future. Rev Infect Dis [Suppl 5] 11:S898-S901

    Google Scholar 

  2. Williams REO (1973) Benefit and mischief from commensal bacteria. J Clin Pathol 26:811–818

    Google Scholar 

  3. Kirrstetter R, Durckheimer W (1989) Development of new β-lactam antibiotics, derived from natural and synthetic sources. Die Pharmazie 44:177–185

    Google Scholar 

  4. Hamilton-Miller JMT (1984) Use and abuse of antibiotics. Br J Clin Pharmacol 18:469–474

    Google Scholar 

  5. McDermott W (1982) Social ramifications of control of microbial disease. Johns Hopkins Med J 151:302–312

    Google Scholar 

  6. Brumfitt W, Hamilton-Miller JMT (1989) Methicillin-resistant Staphylococcus aureus. New Engl J Med 320:1188–1196

    Google Scholar 

  7. Barber M, Csillag A (1958) Staphylococcal infection resistant to chloramphenicol, erythromycin and novobiocin. Br Med J ii:1377–1380

    Google Scholar 

  8. Price DJE, Sleigh JD (1970) Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet i:230–233

    Google Scholar 

  9. Perlman D (1980) Some problems on the new horizons of applied microbiology. Dev Indust Microbiol 21:XV-XXIII

    Google Scholar 

  10. Hamilton-Miller JMT, Iliffe A (1985) Antimicrobial resistance in coagulase-negative staphylococci. J Med Microbiol 19:217–226

    Google Scholar 

  11. Cohen SP, McMurry LM, Hooper DC, Wolfson JS, Levy SB (1989) Cross-resistance to fluoroquinolones in multiple-antibiotic resistant (Mar) Escherichia coli selected by tetracycline or chloramphenicol: decreased drug accumulation associated with membrane changes in addition to OmpF reduction. Antimicrob Agents Chemother 33:1318–1325

    Google Scholar 

  12. Trallero FP, Arenzana JMG, Egana MU (1989) Erythromycin resistance in streptococci. Lancet ii:444–445

    Google Scholar 

  13. Klugman KP, Koornhof JH (1989) Worldwide increase in pneumococcal antibiotic resistance. Lancet ii:444

    Google Scholar 

  14. Kunin CM (1985) The responsibility of the Infectious Disease Community for the optimal use of antimicrobial agents. J Infect Dis 151:388–398

    Google Scholar 

  15. Waksman SA (1949) Streptomycin: nature and practical applications. Bailliere, London

    Google Scholar 

  16. Binda G, Domenichini E, Gottardi A, Orlandi B, Ortelli E, Pacini B, Fowst G (1971) Rifampicin, a general review. Arzneimitt Forsch 21:1907–1978

    Google Scholar 

  17. Stamey TA, Bragonje J (1976) Resistance to nalidixic acid. A misconception due to underdosage. J Am Med Ass 236:1857–1860

    Google Scholar 

  18. Phillips I, Shannon K (1989) Class I β-lactamases: induction and derepression. Drugs 37:402–407

    Google Scholar 

  19. Hamilton-Miller JMT (1974) Non-emergence of polyene-resistant yeasts: An hypothesis. Microbios 10A:91–95

    Google Scholar 

  20. O'Brien TF et al. (1987) Resistance of bacteria to antibacterial agents: Report of Task Force 2. Rev Infect Dis [Suppl 3] 9:S244-S260

    Google Scholar 

  21. Col NF, O'Connor RW (1987) Estimating worldwide current antibiotic usage: Report of Task Force 1. Rev Infect Dis [Suppl 3] 9:S 232–243

    Google Scholar 

  22. Hamilton-Miller JMT, Purves D (1986) Trimethoprim resistance and trimethoprim usage in and around the Royal Free Hospital in 1985. J Antimicrob Chemother 18:643–644

    Google Scholar 

  23. Gruneberg RN (1986) The use of antibiotics in urinary tract infections. In: Asscher AW, Brumfitt W (eds) Microbial diseases in nephrology. Wiley, Chichester, pp 311–323

    Google Scholar 

  24. Hamilton-Miller JMT (1972) A comparative study of amphotericin B, clotrimazole and 5-fluorocytosine against clinically isolated yeasts. Sabouraudia 10:276–283

    Google Scholar 

  25. Loulergue J, Pinon G, Laudat P, Audurier A (1984) La resistance a la fosfomycine chez Staphylococcus saprophyticus et chez les autres especes de staphylocoques coagulase negative. Ann Microbiol (Institut Pasteur) 135A:239–247

    Google Scholar 

  26. Smith DH (1967) R-factor infection of Escherichia coli lyophilized in 1946. J Bacteriol 94:2071–2072

    Google Scholar 

  27. Hamilton-Miller JMT, Grey D (1975) Resistance to trimethoprim in Klebsiellae isolated before its introduction. J Antimicrob Chemother 1:213–218

    Google Scholar 

  28. Milatovic D, Braveny I (1987) Development of resistance during antibiotic therapy. Eur J Clin Microb 6:1–11

    Google Scholar 

  29. Brumfitt W, Hamilton-Miller JMT (1987) Principles and practice of antimicrobial chemotherapy. In: Speight TM (ed) Avery's drug treatment, 3rd edn. ADIS Press, Auckland, pp 1207–1235

    Google Scholar 

  30. Hamilton-Miller JMT (1978) Use of laboratory tests in predicting the therapeutic efficacy of antimicrobial compounds. In: Brumfitt W, Hamilton-Miller JMT (eds) New perspectives in clinical microbiology. Kluwer, London, pp 31–43

    Google Scholar 

  31. Sanders CC, Sanders WE, Goering RV, Werner V (1984) Selection of miltiple antibiotic resistance by quinolones, β-lactams, and aminoglycosides with special reference to cross-resistance between unrelated drug classes. Antimicrob Agents Chemother 26:797–801

    Google Scholar 

  32. Smith HW (1976) Mutants of Klebsiella pneumoniae resistant to several antibiotics. Nature 259:307–308

    Google Scholar 

  33. Gutmann L, Williamson R, Moreau N, Kitzis M-D, Collatz E, Acar JF, Goldstein FW (1985) Cross-resistance to nalidixic acid, trimethoprim, and chloramphenicol with alterations in outer membrane proteins of Klebsiella, Enterobacter and Serratia. J Infect Dis 151:501–507

    Google Scholar 

  34. Lorian V, Gardner DA (1985) Bacterial resistance to antibiotics in American hospitals. Chemioterapia 4:14–18

    Google Scholar 

  35. Young LS, Hindler J (1986) Aminoglycoside resistance: A worldwide perspective. Am J Med [Suppl 6B] 80:15–22

    Google Scholar 

  36. Lane MM, Parker DE, Flournoy DJ (1985) Trends in bacterial susceptibility to antimicrobial agents. Chemotherapy 31:433–439

    Google Scholar 

  37. Flournoy DJ (1985) Influence of aminoglycoside usage of susceptibilities. Chemotherapy 31:178–180

    Google Scholar 

  38. Kresken M, Wiedemann B (1986) Development of resistance in the past decade in Central Europe. J Antimicrob Chemother [Suppl C] 18:235–242

    Google Scholar 

  39. O'Brien T et al. (1986) Resistance to antibiotics at medical centres in different parts of the world. J Antimicrob Chemother [Suppl C] 18:243–253

    Google Scholar 

  40. Maple P, Hamilton-Miller JMT, Brumfitt W (1989) Ciprofloxacin resistance in methicillin and gentamicin-resistant Staphylococcus aureus. Eur Clin Microbiol Infect Dis 8:622–624

    Google Scholar 

  41. Bosso JA, Allen JE, Matsen JM (1989) Changing susceptibility of Pseudomonas aeruginosa isolates from cystic fibrosis patients with the clinical use of new antibiotics. Antimicrob Agents Chemother 33:526–528

    Google Scholar 

  42. Quinn JP, Miyashiro D, Sahm D, Flamm R, Bush K (1989) Novel plasmid-mediated β-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother 33:1451–1456

    Google Scholar 

  43. Greek Society for Microbiology (1989) Antibiotic resistance among Gram-negative bacilli in 19 Greek hospitals. J Hosp Infect 14:177–181

    Google Scholar 

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  1. Department of Medical Microbiology, Royal Free Hospital and School of Medicine, Pond Street, NW3 2QG, London, UK

    J. M. T. Hamilton-Miller

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  1. J. M. T. Hamilton-Miller
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Hamilton-Miller, J.M.T. The emergence of antibiotic resistance: Myths and facts in clinical practice. Intensive Care Med 16 (Suppl 3), S206–S211 (1990). https://doi.org/10.1007/BF01709702

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