How to Overcome the Antibiotic Crisis
With the advent of the antibiotic era, the overuse and inappropriate consumption and application of antibiotics have driven the rapid emergence of multidrug resistant pathogens. Antimicrobial resistance increases the morbidity, mortality, length of hospitalization and healthcare costs. Among Gram positive bacteria, Staphylococcus aureus (MRSA) and multidrug resistant (MDR) Mycobacterium tuberculosis, and among the Gram negative bacteria, extended spectrum beta lactamase (ESBLs) producing bacteria have become a major global healthcare problem in the 21st century. The pressure to use antibiotics guarantees that the spread and prevalence of these as well as of future emerging multidrug resistant pathogens will be a persistent phenomenon. The unfeasibility of reversing antimicrobial resistance back towards susceptibility and the critical need to treat bacterial infection in modern medicine have burdened researchers and pharmaceutical companies to develop new antimicrobials effective against these difficult to treat multidrug resistant pathogens. However, it can be anticipated that antibiotic resistance will continue to develop more rapidly than new agents to treat these infections become available and a better understanding of the molecular, evolutionary and ecological mechanisms governing the spread of antibiotic resistance is needed. The only way to curb the current crisis of antimicrobial resistance will be to develop entirely novel strategies to fight these pathogens such as combining antimicrobial drugs with other agents that counteract and obstruct the antibiotic resistant mechanisms expressed by the pathogen. Furthermore, as many antibiotics are often inappropriately prescribed, a more personalized approach based on precise diagnosis tools will ensure that proper treatments can be promptly E. Medina Infection Immunology Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany e mail: eva.medina@helmholtz hzi.de D.H. Pieper Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany e mail: dietmar.pieper@helmholtz hzi.de Current Topics in Microbiology and Immunology (2016) 398: 3 33 DOI 10.1007/82_2016_492 (c) Springer International Publishing AG 2016 Published Online: 24 February 2016 applied leading to more targeted and effective therapies. However, in more general terms, also the overall use and release of antibiotics in the environment needs to be better controlled. List of Abbreviations CA MRSA Community acquired methicillin resistant Staphylococcus aureus CDC Center for Disease Control and Prevention CRE Carbapenem resistant Enterobacteriacea DOTS Direct Observed Treatment Short Course ESBL Extended spectrum b lactamase ESKAPE Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. FDA Food and Drug Administration H MRSA Hospital acquired methicillin resistant Staphylococcus aureus hVISA Heterogeneous vancomycin intermediate Staphylococcus aureus IDSA Infectious Diseases Society of America IMP Metallo b lactamase active on imipenem KPC Klebsiella pneumoniae carbapenemases LPS Lipopolysaccharide MDR Multidrug resistant MDR TB Multidrug resistant tuberculosis MIC Minimum inhibitory concentration MRAB Multidrug resistant Acinetobacter baumannii MRSA Methicillin resistant Staphylococcus aureus MSSA Methicillin susceptible Staphylococcus aureus MYSTIC Meropenem Yearly Susceptibility Test Information Collection NDM New Delhi b lactamase PBP2a Penicillin binding protein 2a PDR Pandrug resistant SIM Seoul imipenemase SME Serratia marcescens enzyme TDR TB Totally drug resistant tuberculosis VIM Verona integron encoded metallo b lactamase VISA Vancomycin intermediate resistant Staphylococcus aureus VRSA Vancomycin resistant Staphylococcus aureus WHO World Health Organization XDR Extensive drug resistant XDR TB Extensive drug resistant tuberculosis 4 E. Medina and D.H. Pieper
Current Topics in Microbiology and Immunology