Mechanisms of bacterial resistance to antibiotics

Article Abstract:

A review is presented on the mechanisms of bacterial resistance to antibiotics, which is of increasing importance in both community-based and hospital-acquired (nosocomial) infections. Bacteria have developed that are resistant to every antibiotic used, and several mechanisms of this resistance have been discovered. The emphasis in this review is on mechanisms of resistance to antibiotics whose normal way of acting is to inhibit synthesis of the bacterial cell wall (essential for survival of the microorganism). Three basic mechanisms are: (1) degradation of the antibiotic by enzymes produced by the bacteria; (2) changes in the bacterial proteins that would normally be targets of the antibiotic so that they do not bind the antibiotic as well; and (3) changes in the permeability of the outer membrane of the bacterial cell wall (the ease with which substances cross it) so that antibiotics cannot enter the membrane as easily to bind to the appropriate proteins. Mechanisms of resistance to different classes of antibiotics are described. Bacterial resistance can be combatted by modifying currently used antibiotics, or by administering antibiotics with non-antibiotic drugs that inhibit enzymatic degradation. It is possible that the development of antibiotic-resistant bacterial strains can be hindered by: prescribing antibiotics for short periods only; prescribing drugs with narrow spectrums of action when the infectious organism is known; or by limiting oral or topical use of antibiotics that may need to be injected to treat more serious illness. While the effects of less careful prescribing of these drugs on the development of resistant strains are not known, the drugs should probably be used with caution until more research on the subject has been completed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Drug resistance in microorganisms, Microbial drug resistance, Bacterial genetics

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Outpatient management of uncomplicated lower-extremity infections in diabetic patients

Article Abstract:

Foot infections in patients with diabetes are caused by aerobic, or oxygen-requiring, and anaerobic, or oxygen-independent, bacteria. Diabetic foot infections are commonly treated in the hospital with antibiotics given intravenously (IV), or directly into the circulation. The effectiveness of oral antibiotics given on an outpatient basis in the treatment of lower extremity infections in patients with diabetes was evaluated. None of the infections threatened the survival of a limb. Fifty-six patients were given either clindamycin hydrochloride or cephalexin for two weeks and examined every three to seven days. Each patient was infected with an average of two microorganisms. Fifty patients were infected with aerobic gram-positive cocci, which were the only infecting agent in 21 of these cases. Aerobic gram-negative bacilli were isolated in 20 cases and anaerobes in 7 cases, most often occurring as a multi-infection. Of 51 infections that were eliminated, 42 resolved and 9 improved after two weeks of oral antibiotic therapy. Five cases did not respond to the oral antibiotics; three were subsequently treated with further outpatient oral antibiotic therapy. After an average of 15 months, 43 of the cured patients required no further treatment. The results show that lower-extremity infections in diabetic patients are most often caused by aerobic gram-positive cocci, and are effectively treated with oral antibiotics, which can be given on an outpatient basis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Infection, Complications and side effects, Drug therapy, Diabetes, Diabetes mellitus, Bacterial infections, Ambulatory medical care, Ambulatory care, Foot

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