title: [The threat of antibiotic resistance: origin, impact and public health perspectives].
abstract: Bacterial resistance to antibiotics is as old as the living planet, i.e. over 3 billion years ago when bacterial life emerged together with its biological warfare weapons, the antibiotics. Bacteria can readily develop a diverse array of antibiotic resistance mechanisms, including selection of mutants which produce modified low-affinity drug targets, exhibit reduced drug permeability or increased drug efflux. Another pathway is through acquisition of mobile genetic determinants of drug inactivating enzymes, target protection or bypass mechanisms. Antibiotic resistance has accelerated and spread across the community of human and animal bacteria following massive use of antibiotics for over half-a century in human and veterinary medicine and agriculture. Today, the increasing prevalence of resistance among many bacterial pathogens is no longer counter-balanced by the launching of innovative and active antibiotics. This imbalanced "arms race" undermines the escalating use of broad-spectrum antibiotics and increases the risk of therapeutic failure, drug side effets and excess costs of care. The accumulation of antibiotic resistance genes and their epidemic dissemination is fuelled by the selective pressure associated with excess and inappropriate use of antibiotics combined with insufficient infection prevention and control measures. Confronting this threat effectively requires new strategies to be implemented globally, nationally, and locally across all healthcare and agricultural sectors.
authors.affiliation: Service de Microbiologie, Hôpital Erasme et Ecole de Santé Publique, Unité d'Epidémiologie des Maladies Infectieuses, U.L.B., Bruxelles.
authors.forename: M J
authors.initials: MJ
authors.lastname: Struelens
authors.forename: O
authors.initials: O
authors.lastname: Denis
authors.forename: H
authors.initials: H
authors.lastname: Rodriguez-Villalobos
authors.forename: M
authors.initials: M
authors.lastname: Hallin
mesh_terms: D001419:Bacteria / Q000187:drug effects; D001424:Bacterial Infections / Q000188:drug therapy* / Q000235:genetics; D001530:Belgium; D024881:Drug Resistance, Bacterial; D006801:Humans; D011634:Public Health