The Emergence of Resistant Gram-negative Bacteria - Are We Entering the Post-antibiotic Era?

The discovery of antibiotics is considered to be one of the most important medical developments. With the availability of effective and safe antimicrobial agents, millions of people have survived previously deadly infections. However, these important agents are now losing their effectiveness, due to the rapid emergence of resistance, especially in gram-negative micro-organisms. The emergence of resistance is due mainly to a massive use of antibiotics in humans and animals. Many of the antibiotic prescriptions in humans, and most in animals, are not necessary and could be avoided. Also, infection control in healthcare settings should be optimised to prevent the spread of resistance between patients by improving the implementation of existing guidelines. Finally, we need new antimicrobial agents and this should be a top priority in medical research and development. New agents are not to be expected in the next five to 10 years and we will have to live with the currently available agents in the coming years. Therefore, it is important to define guidelines on the laboratory detection, treatment and prevention of infections with extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae. The implementation of rapid and accurate laboratory detection methods is crucial in the prevention of nosocomial transmission of resistant bacteria within healthcare settings and in the timely administration of appropriate antimicrobial therapy.