title: Beta-lactam resistance in the gram negatives: increasing complexity of conditional, composite and multiply resistant phenotypes.
abstract: The greatest impact of microbiology data on clinical care is in the critically ill. Unfortunately, this is also the area in which microbiology laboratories are most often non-contributive. Attempts to move to rapid, culture-independent diagnostics are driven by the need to expedite urgent results. This is difficult in Gram-negative infection because of the complexity of the antibiotic resistance phenotype. Here, we discuss resistance to modern beta-lactams as a case in point. Recent outbreaks of transmissible carbapenem resistance among Gram-negative enteric pathogens in Sydney and Melbourne serve to illustrate the pitfalls of traditional phenotypical approaches. A better understanding of the epidemiology and mosaic nature of antibiotic resistance elements in the microflora is needed for us to move forward.
authors: Centre for Infectious Diseases and Microbiology, University of Sydney, Australia. joni@icpmr.wsahs.nsw.gov.au
authors: Jon
authors: J
authors: Iredell
authors: Lee
authors: L
authors: Thomas
authors: Björn
authors: B
authors: Espedido
mesh_terms: D001315:Australia; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D005838:Genotype; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000201:enzymology / Q000502:physiology*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D010641:Phenotype; D009626:Terminology as Topic; D018440:beta-Lactam Resistance / Q000502:physiology*; D001618:beta-Lactamases / Q000502:physiology
chemical_list: D015780:Carbapenems; D001618:beta-Lactamases