Community acquired infections and bacterial resistance

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Abstract
In this paper we review the problems of antibiotic resistance in community acquired infections. We discuss pathogens that have a large impact on morbidity and mortality in the community such as Streptococcus pneumoniae , Streptococcus pyogenes , Neisseria meningitidis , the enteric pathogens Salmonella spp and Campylobacter spp, and the urinary tract pathogen Escherichia coli . #### Summary points The frequency of resistance to antibiotics among community acquired pathogens and the number of drugs to which they are resistant is increasing Resistance to antimicrobial drugs has been clearly linked to consumption of antibiotics The boundaries between community and hospital environments are becoming more blurred and this may have consequences for the development of resistance to antimicrobial drugs Strategies to limit the spread of resistant strains should include encouraging the judicious use of antimicrobial agents Guidelines should be based on results derived from well designed surveillance studies Infection with S pneumoniae is the biggest cause of potentially life threatening, community acquired diseases such as meningitis and pneumonia. It is also the leading bacterial cause of otitis media and sinusitis. However, this pathogen has evolved to reach unexpected levels of resistance to antibiotics. Before the early 1990s most pneumococci isolated in the European Union and the United States were susceptible to penicillin, with minimum inhibitory concentrations of <0.1 mg/l1; this concentration of penicillin killed these organisms rapidly. Since then, resistance to penicillin has increased substantially in certain European countries and in the United States. 2 3 Unfortunately, different authors have used different inhibitory concentrations to define penicillin resistance. However, susceptibility to penicillin is defined by many authors as a minimum inhibitory concentration of <0.1 mg/l; penicillin resistance is classed as intermediate when the minimum inhibitory concentration for S pneumoniae is 0.1-1.0 mg/l, and high when the minimum inhibitory concentration is 2.0 mg/l. Treatment regimens have been proposed …