The medical need for new agents
Abstract number: 1133_104
Dramatic increases in the prevalence of antibacterial resistance have occurred in recent years as an inevitable evolutionary response to the extensive use of antibacterial agents. The efficacy of new and existing agents continues to be compromised, both by the transmission of existing mechanisms via clonal spread and by new, emergent mechanisms of resistance. Antibacterial resistance occurs across all bacteria, both Gram-positive and Gram-negative, and is widespread amongst community-acquired and nosocomial infections. In the community, instances of multi-drug-resistant Streptococcus pneumoniae, in which strains are resistant to three or more drug classes, are becoming common and increasingly include resistance to fluoroquinolones as well as beta-lactams, macrolides and other classes. Furthermore, community strains of MRSA are beginning to arise independently of nosocomial strains and can exhibit increased virulence. New surveillance data show that community strains of Enterobacteriaceae act as reservoirs for extended-spectrum beta-lactamase (ESBL) resistance, the extent and types of which are increasing. Fluoroquinolone resistance in E. coli is also increasing and exceeds 50% in much of S.E. Asia.
New patterns of resistance are being observed in hospital-acquired infections. MRSA is frequently observed in this environment and is becoming increasingly difficult to treat as strains become resistant to almost all available drug classes. In the mid-1990s, the first strains of MRSA with decreased susceptibility to vancomycin were detected, and the vanA gene has been identified in 3 independent strains of MRSA. Severe hospital-acquired infections are frequently caused by Gram-negative pathogens such as Pseudomonas aeruginosa, Acinetobacter spp. and Stenotrophomonas maltophila. These pathogens are resistant to many beta-lactams, and although resistance to many carbapenems remains rare, resistance to those of the IMP, VIM and OXA family is increasing.
|Session name:||XXIst ISTH Congress|
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