The role of the natural environment in the emergence of antibiotic resistance in gram-negative bacteria.
During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.
School of Life Sciences, University of Warwick, Coventry, UK. e.m.h.wellington@warwick.ac.uk
Elizabeth M H
EM
Wellington
Alistair B
AB
Boxall
Paul
P
Cross
Edward J
EJ
Feil
William H
WH
Gaze
Peter M
PM
Hawkey
Ashley S
AS
Johnson-Rollings
Davey L
DL
Jones
Nicholas M
NM
Lee
Wilfred
W
Otten
Christopher M
CM
Thomas
A Prysor
AP
Williams
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D059647:Gene-Environment Interaction; D016680:Genome, Bacterial; D006090:Gram-Negative Bacteria / Q000235:genetics*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008372:Manure / Q000382:microbiology; D008954:Models, Biological; D011815:R Factors; D012722:Sewage / Q000737:chemistry / Q000382:microbiology
D000900:Anti-Bacterial Agents; D008372:Manure; D012722:Sewage