Education And Debate

Community acquired infections and bacterial resistance

BMJ 1998; 317 doi: (Published 05 September 1998) Cite this as: BMJ 1998;317:654
  1. Herman Goossens, professor of microbiologya,
  2. Marc J W Sprenger, head of departmentb
  1. a Department of Clinical Microbiology, Antwerp University Hospital, B-2650 Edegem, Belgium
  2. bDepartment of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands
  1. Correspondence to: Dr Goossens

    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

    Streptococcus pneumoniae

    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 …

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