Antimicrobial Resistance
Trends
The 1990s is the era of multidrug resistance. Some bacteria causing several kinds of human infectious diseases are resistant to multiple antibiotics and are continuing to increase. Resistant infections confront and thwart the treatment of some patients in the community as well as in the hospital. Major resistant hospital organisms include Staphylococcus aureus, enterococcus, Klebsiella, Enterobacter, Escherichia coli, Pseudomonas and more recently Acinetobacter. Multidrug resistant bacteria causing community acquired infections include pneumococcus, gonococcus, Mycobacterium tuberculosis, group A streptococci and E. coli.
Scope Of Problem
The antibiotic resistance problem is global, confronting communities and nations worldwide. Resistant organisms may spread from one country to the other. Of note is the documented spread of resistant pneumococci from Spain to Iceland, France and the United States.
Sequelae
Resistance thwarts treatment of ear infections in children, sinusitis, urinary tract infections, pneumonia, septicemias and meningitis. In the United States deaths have been linked to resistance in two disease-causing organisms: the enterococcus in hospitals and tuberculosis in the community and the hospital.
Costs
The costs of antibiotic resistance continue to rise. Mortality and hospital length of stay are at least doubled for resistant strains of some organisms compared with susceptible ones.
Challenges and Goals
About half of the pharmaceutical companies in the United States left the antimicrobial field in the mid 1980s. Recently, they are returning in response to the need. Educational projects for physicians and patients should be emphasized. Antibiotic use must improve so as to preserve efficacy of the drugs we have. More research support is needed in order to define the molecular basis for resistance and to find ways to circumvent it. Better surveillance systems for antibiotic resistance are needed. Interaction and interrelationships between surveillance groups, both in animal and human microbiology need to be established and solidified.
Risk Groups
Risk groups include hospitalized and immunocompromised persons, children attending daycare and elderly patients in nursing homes.
Research Priorities
- To develop molecular methods for detecting resistance.
- To develop surveillance systems using practitioners, hospital and private laboratories, and HMOs to detect new resistance mechanisms and to detect the development of resistance in normally susceptible organisms.
- To develop drugs and other means to deal with newly-resistant organisms.
- To enhance public awareness that the problem is real and that antimicrobial treatment is not always a good plan.
April 1997
