Beta-lactam resistance in the gram negatives: increasing complexity of conditional, composite and multiply resistant phenotypes.
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.
Iredell
Jon
J
Centre for Infectious Diseases and Microbiology, University of Sydney, Australia. joni@icpmr.wsahs.nsw.gov.au
Thomas
Lee
L
Espedido
Björn
B
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
D015780:Carbapenems; D001618:beta-Lactamases