Fourteen years in resistance.

摘要: Resistance trends have changed greatly over the 14 years (1997–2011) whilst I was Director of UK Antibiotic Monitoring and Reference Laboratory (ARMRL). Meticillin-resistant Staphylococcus aureus (MRSA) first rose, then fell with improved infection control, although decline one major clone beginning before these improvements. Resistant pneumococci too declined following conjugate vaccine deployment. If situation against Gram-positive pathogens has improved, that Gram-negatives worsened, spread (i) quinolone- cephalosporin-resistant Enterobacteriaceae, (ii) Acinetobacter OXA carbapenemases, (iii) Enterobacteriaceae biochemically diverse carbapenemases (iv) gonococci resistant to fluoroquinolones and, latterly, cefixime. Laboratory, clinical commercial aspects also changed. Susceptibility testing is more standardised, pharmacodynamic breakpoints. Treatments regimens are driven by guidelines. The industry fewer big profitable companies small without sales income. There good bad here. quality routine susceptibility but its speed not. Pharmacodynamics adds science, over-optimism led poor dose selection in several trials. Guidelines discourage therapy concentrate onto a diminishing range antibiotics, threatening their utility. Small nimble, less resilient. Last, than anything, world changed, rise India China, which account for 33% world's population increasingly provide sophisticated health care, huge resistance problems. These shifts present challenges future chemotherapy edifice modern medicine depends upon it.