Multiple drug resistance
Multiple drug resistance (MDR), multidrug resistance or multiresistance is
Recognizing different degrees of MDR in bacteria, the terms extensively drug-resistant (XDR) and pandrug-resistant (PDR) have been introduced. Extensively drug-resistant (XDR) is the non-susceptibility of one bacteria species to all antimicrobial agents except in two or less antimicrobial categories. Within XDR, pandrug-resistant (PDR) is the non-susceptibility of bacteria to all antimicrobial agents in all antimicrobial categories.[1] The definitions were published in 2011 in the journal Clinical Microbiology and Infection and are openly accessible.[1]
Common multidrug-resistant organisms (MDROs)
Common multidrug-resistant organisms, typically bacteria, include:[3]
- Vancomycin-Resistant Enterococci (VRE)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Extended-spectrum β-lactamase (ESBLs) producing Gram-negative bacteria
- Klebsiella pneumoniae carbapenemase (KPC) producing Gram-negatives
- Multidrug-resistant Gram negative rods (MDR GNR)
- Multi-drug-resistant tuberculosis
Overlapping with MDRGN, a group of
Bacterial resistance to antibiotics
Various microorganisms have survived for thousands of years by their ability to adapt to
- No longer relying on a glycoprotein cell wall[citation needed]
- Enzymatic deactivation of antibiotics[6]
- Decreased cell wall permeability to antibiotics[7]
- Altered target sites of antibiotic[8]
- Efflux mechanisms to remove antibiotics[9]
- Increased mutation rate as a stress response[10]
Many different bacteria now exhibit multi-drug resistance, including
Bacterial resistance to bacteriophages
Phage-resistant bacteria variants have been observed in human studies. As for antibiotics, horizontal transfer of phage resistance can be acquired by plasmid acquisition.[13]
Antifungal resistance
Yeasts such as Candida species can become resistant under long-term treatment with azole preparations, requiring treatment with a different drug class. Lomentospora prolificans infections are often fatal because of their resistance to multiple antifungal agents.[14]
Antiviral resistance
HIV is the prime example of MDR against antivirals, as it mutates rapidly under monotherapy.
Antiparasitic resistance
The prime example for MDR against antiparasitic drugs is
Preventing the emergence of antimicrobial resistance
To limit the development of antimicrobial resistance, it has been suggested to:[citation needed]
- Use the appropriate antimicrobial for an infection; e.g. no antibiotics for viral infections
- Identify the causative organism whenever possible
- Select an antimicrobial which targets the specific organism, rather than relying on a broad-spectrum antimicrobial
- Complete an appropriate duration of antimicrobial treatment (not too short and not too long)
- Use the correct dose for eradication; subtherapeutic dosing is associated with resistance, as demonstrated in food animals.
- More thorough education of and by prescribers on their actions' implications globally.
The medical community relies on education of its prescribers, and self-regulation in the form of appeals to voluntary antimicrobial stewardship, which at hospitals may take the form of an antimicrobial stewardship program. It has been argued that depending on the cultural context government can aid in educating the public on the importance of restrictive use of antibiotics for human clinical use, but unlike narcotics, there is no regulation of its use anywhere in the world at this time. Antibiotic use has been restricted or regulated for treating animals raised for human consumption with success, in Denmark for example.[19]
It is necessary to develop new antibiotics over time since the selection of resistant bacteria cannot be prevented completely. This means with every application of a specific antibiotic, the survival of a few bacteria which already got a resistance gene against the substance is promoted, and the concerning bacterial population amplifies. Therefore, the resistance gene is farther distributed in the organism and the environment, and a higher percentage of bacteria means they no longer respond to a therapy with this specific antibiotic. In addition to developing new antibiotics, new strategies entirely must be implemented in order to keep the public safe from the event of total resistance. New strategies are being tested such as UV light treatments and bacteriophage utilization, however more resources must be dedicated to this cause.
See also
- Drug resistance
- MDRGN bacteria
- Xenobiotic metabolism
- NDM1 enzymatic resistance
- Herbicide resistance
- P-glycoprotein
References
- ^ a b c d A.-P. Magiorakos, A. Srinivasan, R. B. Carey, Y. Carmeli, M. E. Falagas, C. G. Giske, S. Harbarth, J. F. Hinndler et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria... Archived 6 December 2017 at the Wayback Machine. Clinical Microbiology and Infection, Vol 8, Iss. 3 first published 27 July 2011 [via Wiley Online Library]. Retrieved 16 August 2014.
- ^ Drug+Resistance,+Multiple at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
- from the original on 18 October 2022. Retrieved 15 December 2023.
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- ^ Hussain, T. Pakistan at the verge of potential epidemics by multi-drug resistant pathogenic bacteria (2015). Adv. Life Sci. 2(2). pp: 46-47
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- ^ Dondorp, A., Nosten, F., Yi, P., Das, D., Phyo, A., & Tarning, J. et al. (2009). Artemisinin Resistance in Plasmodium falciparum Malaria. New England Journal Of Medicine, 361, 455-467.
- ^ Doliwa C, Escotte-Binet S, Aubert D, Velard F, Schmid A, Geers R, Villena I. Induction of sulfadiazine resistance in vitro in Toxoplasma gondii.Exp Parasitol. 2013 Feb;133(2):131-6.
- ^ Laurenson YC, Bishop SC, Forbes AB, Kyriazakis I.Modelling the short- and long-term impacts of drenching frequency and targeted selective treatment on the performance of grazing lambs and the emergence of antihelmintic resistance.Parasitology. 2013 Feb 1:1-12.
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- PMID 28807909.
Further reading
- Greene HL, Noble JH (2001). Textbook of primary care medicine. St. Louis: Mosby. ISBN 978-0-323-00828-0.
External links
- BURDEN of Resistance and Disease in European Nations - An EU project to estimate the financial burden of antibiotic resistance in European Hospitals
- European Centre of Disease Prevention and Control and (ECDC): Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance Disease Programmes Unit
- State of Connecticut Department of Public Health MDRO information MultidrugResistant Organisms MDROs What Are They