Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Antibiotic resistance
The term antibiotic resistance refers to the ability of bacteria and other micro-organisms to withstand the effects of an antibiotic to which it was previously sensitive. Consequently, these resistant organisms are not inhibited by antibiotics at the serum/tissue concentrations achievable after normal dosing of the drug. In contrast to other drugs, antibiotics are unique in that the use of these agents in one patient can influence future efficacy – not only in the same patient but also for other patients and potentially a whole population.
- The widespread use of antibiotics has exerted selective resistance pressure, and this, coupled with the transfer of microorganisms between people, has led to the emergence of antibiotic resistance. The abundance and variation in resistance genes in bacteria became established after extensive use of antibiotics in various clinical & agricultural settings.
- Antimicrobial resistance is increasing in many pathogens. Problem organisms include streptococcus pneumoniae, Methicillin-resistant Staphylococcus aureus (MRSA) (both in the wider community and in hospitals), vancomycin resistant enterococci (VRE), strains of Klebsiella, and pseudomonas aeruginosa.
- Antibiotic resistance can be acquired by spontaneous gene mutation, but the most common mechanism is the acquisition of resistance genes by bacteria through the mechanism of plasmid transmission. Bacteria may acquire resistance to multiple antibiotics via plasmid transfer.
- In the aged care sector, various strategies can combat antibiotic resistance including restricting the use of broad-spectrum agents, avoiding empirical therapy. using culture and sensitivity where possible to guide the choice of agent, and minimising the duration of treatment to the shortest effective course.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.