New Aspects of Antimicrobial Resistance and the Resulting Therapeutic Dilemmas

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Abstract
Emergence ofresistance to antimicrobial agents amongpreviously susceptible organisms continuesto bean important obstacle to thesuccessful treatmentofbacterial infections. In hospitals, plasmid-mediated resistance to third-generation cephalosporins and monobactams has recently appearedin gram-negative bacilli, dueprimarily to mutations in TEM- and SHY-type enzymes. Among nosocomial enterococci, vancomycin resistance, β-lactamase production, and high-level resistance to all aminoglycosides have recently been addedto thisorganism's already formidable armamentarium of resistance properties. Also, resistance to ftuoroquinolones and rifampin has been emerging in methicillin-resistant Staphylococcus aureus. In the community, organisms in which resistance plays a particularly important roleare shigellae, Haemophilus infiuenzue, gonococci, andpneumococci, particularly in developing countries. {3-lactamase-producing meningococci have beenreported forthe firsttime. Theselective pressure generated bytheuseofantimicrobial agents, together with the ability of bacteria to acquire and spread resistance and the capacity ofhumansto transmitbacteria, suggest that antimicrobial resistance will continue to bea problem for the foreseeable future.

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