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Journal of Antimicrobial Chemotherapy 2007 60(Supplement 1):i59-i61; doi:10.1093/jac/dkm160
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Articles

The zeitgeist of resistance

David Livermore*

Antibiotic Resistance Monitoring and Reference Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK

* Tel: +44-208-327-7223; Fax: +44-208-327-6264; E-mail: david.livermore{at}hpa.org.uk

The accumulation of bacterial antibiotic resistance is a dramatic demonstration of Darwin's dictum of the survival of the fittest, with serious practical consequences for the treatment of infection. Patterns and mechanisms of resistance undergo continuous evolution and, while the prevalence of methicillin-resistant Staphylococcus aureus has stabilized in the UK, other resistances are proliferating rapidly, notably those to cephalosporins and quinolones among Gram-negative bacteria; carbapenem resistance is growing too, notably in Acinetobacter spp. In contrast, several much-feared resistances, for example to vancomycin in staphylococci, have failed to accumulate significantly, despite repeated emergence. For a resistance to ‘succeed’, it needs to have a mechanism that imposes little fitness burden, along with a biologically ‘fit’ host strain or strains. Once this combination arises, control is extremely difficult.

Keywords: extended-spectrum ß-lactamase , quinolone resistance , vancomycin-resistant Staphylococcus aureus , MRSA , epidemiology of resistance


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