Abstract
The optimism of the early period of antimicrobial discovery has been tempered by the emergence of bacterial strains with resistance to these therapeutics. Today, clinically important bacteria are characterized not only by single drug resistance but also by multiple antibiotic resistance—the legacy of past decades of antimicrobial use and misuse. Drug resistance presents an ever-increasing global public health threat that involves all major microbial pathogens and antimicrobial drugs.
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References
Levy, S. The Antibiotic Paradox: How Misuse of Antibiotics Destroys their Curative Powers (Perseus Cambridge, 2002).
Ash, C. (ed.) Trends in Microbiology vol.2, 341–422 (Elsevier, Cambridge, UK, 1994).
Levy, S.B. The challenge of antibiotic resistance. Sci. Am. 278, 46–53 (1998).
Levy, S.B. Microbial resistance to antibiotics. An evolving and persistent problem. Lancet 2, 83–88 (1982).
Barber, M. Infection by penicillin resistant Staphylococci. Lancet 2, 641–644 (1948).
Crofton, J. & Mitchison, D.A. Streptomycin resistance in pulmonary tuberculosis. Br. Med. J. 2, 1009–1015 (1948).
Watanabe, T. Infective heredity of multidrug resistance in bacteria. Bacteriol. Rev. 27, 87–115 (1963).
Olarte, J. Antibiotic resistance in Mexico. APUA Newsletter 1, 3ff (1983).
Levy, S.B. Antibiotic resistance: consequences of inaction. Clin. Infect. Dis. 33 Suppl. 3, S124–S129 (2001).
Elwell, L., Roberts, M., Mayer, L. & Falkow, S. Plasmid-mediated β-lactamase production in Neisseria gonorrhoeae. Antimicrob. Agents Chemother. 11, 528–533 (1977).
De Graaff, J., Elwell, L.P. & Falkow, S. Molecular nature of two β-lactamase-specifying plasmids isolated from Haemophilus influenzae type b. J. Bacteriol. 126, 439–446 (1976).
Marshall, B., Roberts, M., Smith, A. & Levy, S.B. Homogeneity of transferable tetracycline resistance determinants in Hemophilus species. J. Infect. Dis. 149, 1028–1029 (1984).
van Klingeren, B., van Embden, J.D. & Dessens-Kroon, M. Plasmid-mediated chloramphenicol resistance in Haemophilus influenzae. Antimicrob. Agents Chemother. 11, 383–387 (1977).
Bloom, B.R. & Murray, C.J.L. Tuberculosis: commentary on a re-emergent killer. Science 257, 1055–1064 (1992).
Iseman, M.D. Treatment of multidrug-resistant tuberculosis. N. Engl. J. Med. [erratum appears in N. Engl. J. Med. 329, 1435 (1993)] 329, 784–791 (1993).
Walsh, F.M. & Amyes, S.G.B. Microbiology and drug resistance mechanisms of fully resistant pathogens. Curr. Opin. Microbiol. 7, 439–444 (2004).
Weinstein, R.A. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerg. Infect. Dis. 7, 188–192 (2001).
Anonymous. European Antimicrobial Resistance Surveillance System. EARSS Annual Report 2002 (2002).
Cosgrove, S.E. et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin. Infect. Dis. 36, 53–59 (2003).
Hiramatsu, K. Vancomycin resistance in staphylococci. Drug Resist. Updat. 1, 135–150 (1998).
Fridkin, S.K. Vancomycin-intermediate and -resistant Staphylococcus aureus: what the infectious disease specialist needs to know. Clin. Infect. Dis. 32, 108–115 (2001).
Weigel, L.M. et al. Genetic analysis of a high-level vancomycin-resistant isolate of Staphylococcus aureus. Science 302, 1569–1571 (2003).
Tenover, F.C. et al. Vancomycin-resistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob. Agents Chemother. 48, 275–280 (2004).
Arthur, M. & Courvalin, P. Genetics and mechanisms of glycopeptide resistance in enterococci. Antimicrob. Agents Chemother. 37, 1563–1571 (1993).
Goossens, H. The epidemiology of vancomycin-resistant enterococci. Curr. Opin. Infect. Dis. 12, 537–541 (1999).
Jones, R.N., Ballow, C.H., Biedenbach, D.J., Deinhart, J.A. & Schentag, J.J. Antimicrobial activity of quinupristin-dalfopristin (RP 59500, Synercid) tested against over 28,000 recent clinical isolates from 200 medical centers in the United States and Canada. Diagn. Microbiol. Infect. Dis. 31, 437–451 (1998).
Meka, V.G. & Gold, H.S. Antimicrobial resistance to linezolid. Clin. Infect. Dis. 39, 1010–1015 (2004).
Bush, K. New β-lactamases in Gram-negative bacteria: diversity and impact on the selection of antimicrobial therapy. Clin. Infect. Dis. 32, 1085–1089 (2001).
Paterson, D.L. et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum β-lactamase production in nosocomial Infections. Ann. Intern. Med. 140, 26–32 (2004).
Bradford, P.A. Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology and detection of this important resistance threat. Clin. Microbiol. Rev. 14, 933–951 (2001).
Nordmann, P. & Poirel, L. Emerging carbapenemases in Gram-negative aerobes. Clin. Microbiol. Infect. 8, 321–331 (2002).
Livermore, D.M. & Woodford, N. Carbapenemases: a problem in waiting? Curr. Opin. Microbiol. 3, 489–495 (2000).
Wang, H., Dzink-Fox, J.L., Chen, M. & Levy, S.B. Genetic characterization of highly fluoroquinolone-resistant clinical Escherichia coli strains from China: role of acrR mutations. Antimicrob. Agents Chemother. 45, 1515–1521 (2001).
Zervos, M.J. et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals, 1991–2000. Clin. Infect. Dis. 37, 1643–1648 (2003).
Karlowsky, J.A., Kelly, L.J., Thornsberry, C., Jones, M.E. & Sahm, D.F. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States. Antimicrob. Agents Chemother. 46, 2540–2545 (2002).
Schrag, S.J. et al. Emergence of Streptococcus pneumoniae with very-high-level resistance to penicillin. Antimicrob. Agents Chemother. 48, 3016–3023 (2004).
McCormick, A.W. et al. Geographic diversity and temporal trends of antimicrobial resistance in Streptococcus pneumoniae in the United States. Nat. Med. 9, 424–430 (2003).
Tanaka, M., Nakayama, H., Haraoka, M. & Saika, T. Antimicrobial resistance of Neisseria gonorrhoeae and high prevalence of ciprofloxacin-resistant isolates in Japan, 1993 to 1998. J. Clin. Microbiol. 38, 521–525 (2000).
Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae—Hawaii and California. Morb. Mortal. Wkly. Rep. 51, 1041–1044 (2002).
Wang, S.A. et al. Multidrug-resistant Neisseria gonorrhoeae with decreased susceptibility to cefixime-Hawaii, 2001. Clin. Infect. Dis. 37, 849–852 (2003).
Vandenesch, F. et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg. Infect. Dis. 9, 978–984 (2003).
Herold, B. et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. J. Am. Med. Assoc. 279, 593–598 (1998).
Anonymous. From the Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus—Minnesota and North Dakota, 1997–1999. J. Am. Med. Assoc. 282, 1123–1125 (1999).
Levy, S.B. Balancing the drug resistance equation. Trends Microbiol. 2, 341–342 (1994).
Levy, S.B. The 2000 Garrod lecture. Factors impacting on the problem of antibiotic resistance. J. Antimicrob. Chemother. 49, 25–30 (2002).
Mellon, M., Benbrook, C. & Benbrook, K.L. Hogging it: estimates of antimicrobial abuse in livestock. (UCS Publications, Cambridge, UK, 2001).
Barza, M., S.L. Gorbach . The need to improve antimicrobial use in agriculture: ecological and human health consequences. Clin Infect. Dis. 34, S71–S144 (2002).
US Congress. Office of Technology Assessment. Impacts of Antibiotic Resistant Bacteria (OTA-H-629, US Government Printing Office, Washington, DC, 1995).
Levy, S.B. & Miller, R.V. (eds.) Gene Transfer in the Environment (McGraw Hill, New York, 1989).
Schneiders, T., Amyes, S.G.B. & Levy, S.B. Role of AcrR and RamA in fluoroquinolone resistance in clinical Klebsiella pneumoniae isolates from Singapore. Antimicrob. Agents Chemother. 47, 2831–2837 (2003).
Piddock, L.J. Mechanisms of fluoroquinolone resistance: an update 1994–1998. Drugs 2 Suppl. 2, 11–18 (1999).
Levy, S.B. Ecology of plasmids and unique DNA sequences. in Engineered Organisms in the Environment: Scientific Issues (eds. Halvorson, H.O., Pramer, D. & Rogul, M.) 180–190 (ASM Press, Washington DC, 1985).
Datta, N. et al. R factors in Escherichia coli in faeces after oral chemotherapy in general practice. Lancet 1, 312–315 (1971).
Moller, J.K., Bak, A.L., Stenderup, A., Zachariae, H. & Afzelius, H. Changing patterns of plasmid-mediated drug resistance during tetracycline therapy. Antimicrob. Agents Chemother. 11, 388–391 (1977).
Levy, S.B., FitzGerald, G.B. & Macone, A.B. Changes in intestinal flora of farm personnel after introduction of a tetracycline-supplemented feed on a farm. N. Engl. J. Med. 295, 583–588 (1976).
Summers, A.O. Generally overlooked fundamentals of bacterial genetics and ecology. Clin. Infect. Dis. 34 Suppl 3, S85–S92 (2002).
Sidhu, M.S., Heir, E., Leegaard, T., Wiger, K. & Holck, A. Frequency of disinfectant resistance genes and genetic linkage with β-lactamase transposon Tn552 among clinical staphylococci. Antimicrob. Agents Chemother. 46, 2797–2803 (2002).
Barbosa, T.M. & Levy, S.B. The impact of antibiotic use on resistance development and persistence. Drug Resist. Updat. 3, 303–311 (2000).
Seppala, H. et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N. Engl. J. Med. 337, 441–446 (1997).
Levy, S.B. Emergence of antibiotic-resistant bacteria in the intestinal flora of farm inhabitants. J. Infect. Dis. 137, 689–690 (1978).
Alekshun, M.N. & Levy, S.B. Regulation of chromosomally mediated multiple antibiotic resistance: the mar regulon. Antimicrob. Agents Chemother. 41, 2067–2075 (1997).
Levy, S.B. Antibiotic resistance: an ecological imbalance, in Antibiotic Resistance: Origins, Evolution, and Spread, 1–9 (J. Wiley, Chichester, UK, 1997).
Levy, S.B. Starting life resistance-free. N. Engl. J. Med. 323, 335–337 (1990).
Miller, Y.W. et al. Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts. J. Antimicrob. Chemother. 38, 829–837 (1996).
Levy, S.B., Marshall, B., Schluederberg, S., Rowse, D. & Davis, J. High frequency of antimicrobial resistance in human fecal flora. Antimicrob. Agents Chemother. 32, 1801–1806 (1988).
Walson, J.L., Marshall, B., Pokhrel, B.M., Kafle, K.K. & Levy, S.B. Carriage of antibiotic-resistant fecal bacteria in Nepal reflects proximity to Kathmandu. J. Infect. Dis. 184, 1163–1169 (2001).
Kummerer, K. & Henninger, A. Promoting resistance by the emission of antibiotics from hospitals and households into effluent. Clin. Microbiol. Infect. 9, 1203–1214 (2003).
Rolland, R.M., Hausfater, G., Marshall, B. & Levy, S.B. Antibiotic-resistant bacteria in wild primates: increased prevalence in baboons feeding on human refuse. Appl. Environ. Microbiol. 49, 791–794 (1985).
Corpet, D.E. Antibiotic resistance from food. N. Engl. J. Med. 318, 1206–1207 (1988).
Levy, S.B. Antibiotic resistant bacteria in food of man and animals, in Antimicrobials and Agriculture (ed. Woodbine, M.) 525–531 (Butterworths, London, 1984).
Marshall, B., Petrowski, D. & Levy, S.B. Inter- and intraspecies spread of Escherichia coli in a farm environment in the absence of antibiotic usage. Proc. Natl. Acad. Sci. USA 87, 6609–6613 (1990).
Vidaver, A. Uses of antimicrobials in plant agriculture. Clin. Infect. Dis. 34, S107–S110 (2002).
DeFlaun, M.F. & Levy, S.B. Genes and their varied hosts, in Gene Transfer in the Environment (eds. Levy, S.B. & Miller, R.V.) 1–32 (McGraw-Hill, New York, 1989).
Cohen, M.L., Wong, E.S. & Falkow, S. Common R-plasmids in Staphylococcus aureus and Staphylococcus epidermidis during a nosocomial Staphylococcus aureus outbreak. Antimicrob. Agents Chemother. 21, 210–215 (1982).
Pearman, J.W. & Grubb, W.B. Preventing the importation and establishment of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in Western Australia. APUA Newsletter 11, 1–2 (1993).
Turnidge, J., Lawson, P., Munro, R. & Benn, R. A national survey of antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals. Med. J. Aust. 150, 69–72 (1989).
Cooper, B.S. et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. Br. Med. J. 329, 533 (2004).
Livermore, D. Can better prescribing turn the tide of resistance? Nat. Rev. Microbiol. 2, 73–78 (2004).
Initial therapy for tuberculosis in the era of multidrug resistance. Recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR Recomm. Rep. 42, 1–8 (1993).
Alekshun, M.S.B.L. Targeting virulence to prevent infection: to kill or not to kill? Drug Discovery Today: Therapeutic Strategies (in the press) (2004).
Projan, S.J. Why is big Pharma getting out of antibacterial drug discovery? Curr. Opin. Microbiol. 6, 427–430 (2003).
Simon, L., Gauvin, F., Amre, D.K. & Saint-Lous, P. & Lacroix, J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin. Infect. Dis. 39, 206–217 (2004).
Markou, N. et al. Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit. Care 7, R78–R83 (2003).
Bifani, P.J. et al. Origin and interstate spread of a New York City multidrug-resistant Mycobacterium tuberculosis clone family. J. Am. Med. Assoc. 275, 452–457 (1996).
Soares, S., Kristinsson, K.G., Musser, J.M. & Tomasz, A. Evidence for the introduction of a multiresistant clone of serotype 6B Streptococcus pneumoniae from Spain to Iceland in the late 1980s. J. Infect. Dis. 168, 158–163 (1993).
Manges, A.R. et al. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N. Engl. J. Med. 345, 1007–1013 (2001).
WHO. Global Strategy for Containment of Antimicrobial Resistance (WHO, Geneva, 2001).
Holmberg, S.D., Solomon, S.L. & Blake, P.A. Health and economic impacts of antimicrobial resistance. Rev. Infect. Dis. 9, 1065–1078 (1987).
Rubin, R.J. et al. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg. Infect. Dis. 5, 9–17 (1999).
Phelps, C.E. Bug/drug resistance. Sometimes less is more. Med. Care 27, 194–203 (1989).
Hall, R.M. et al. Mobile gene cassettes and integrons in evolution. Ann. NY Acad. Sci. 870, 68–80 (1999).
Nandi, S., Maurer, J.J., Hofacre, C. & Summers, A.O. Gram-positive bacteria are a major reservoir of Class 1 antibiotic resistance integrons in poultry litter. Proc. Natl. Acad. Sci. USA 101, 7118–7122 (2004).
Clewell, D.B. & Gawron-Burke, C. Conjugative transposons and the dissemination of antibiotic resistance in streptococci. Annu. Rev. Microbiol. 40, 635–659 (1986).
Roberts, M.C. Tetracycline resistance determinants: mechanisms of action, regulation of expression, genetic mobility, and distribution. FEMS Microbiol. Rev. 19, 1–24 (1996).
Dowson, C.G., Coffey, T.J. & Spratt, B.G. Origin and molecular epidemiology of penicillin-binding-protein-mediated resistance to β-lactam antibiotics. Trends Microbiol. 2, 361–366 (1994).
Spratt, B.G. Resistance to antibiotics mediated by target alterations. Science 264, 388–393 (1994).
Balsalobre, L., Ferrandiz, M.J., Linares, J., Tubau, F. & de la Campa, A.G. Viridans group streptococci are donors in horizontal transfer of topoisomerase IV genes to Streptococcus pneumoniae. Antimicrob. Agents Chemother. 47, 2072–2081 (2003).
Levy, S.B. Active efflux mechanisms for antimicrobial resistance. Antimicrob. Agents Chemother. 36, 695–703 (1992).
Nikaido, H. Multidrug efflux pumps of gram-negative bacteria. J. Bacteriol. 178, 5853–5859 (1996).
Levy, S.B. et al. Nomenclature for new tetracycline resistance determinants. Antimicrob. Agents Chemother. 43, 1523–1524 (1999).
McMurry, L.M. & Levy, S.B. Tetracycline resistance in gram-positive bacteria, in Gram-Positive Pathogens (ASM Press, Washington DC, 2000).
Martinez-Martinez, L., Pascual, A. & Jacoby, G.A. Quinolone resistance from a transferable plasmid. Lancet 351, 797–799 (1998).
Wang, M., Sahm, D.F., Jacoby, G.A. & Hooper, D.C. Emerging plasmid-mediated quinolone resistance associated with the qnr gene in Klebsiella pneumoniae clinical isolates in the United States. Antimicrob. Agents Chemother. 48, 1295–1299 (2004).
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Levy, S., Marshall, B. Antibacterial resistance worldwide: causes, challenges and responses. Nat Med 10 (Suppl 12), S122–S129 (2004). https://doi.org/10.1038/nm1145
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