Chapter 20 : Role of Molecular Methods in Improving Public Health Surveillance of Infections Caused by Antimicrobial-Resistant Bacteria in Health Care and Community Settings

Abstract:

The first multidrug-resistant isolates of Enterobacteriaceae that were recognized as clinically significant were strains of Shigella spp. isolated in Japan in the late 1950s. These strains demonstrated resistance to chloramphenicol, streptomycin, sulfonamides, and tetracycline (1). By 1960, Watanabe and Fukasawa had demonstrated that all four resistance markers were transmissible from Shigella donor strains to recipient strains of Escherichia coli and Salmonella enterica serovar Typhimurium via R-factors (2). Resistance to these and other first-line antimicrobial agents, however, remained rare among other genera of the Enterobacteriaceae. Resistance was seen as an anomaly. The discovery of the TEM beta-lactamase (3), which would become the most common cause of ampicillin and first-generation cephalosporin resistance in contemporary E. coli isolates, was still 6 years away. In the 1970s, reports of multidrug-resistant bacteria began to appear more frequently, and susceptibility to beta-lactams, aminoglycosides, and sulfonamides began to wane (4). Fast-forward to the 21st century when pan-susceptible clinical isolates of bacteria are now rare and multiple drug-resistant organisms (MDROs) representing dozens of bacterial species have been recognized and are spreading worldwide (5). Multidrug-resistant strains of staphylococci, enterococci, pseudomonads, acinetobacters, and members of the Enterobacteriaceae family are isolated with increasing frequency in clinical microbiology laboratories around the world, and controlling their spread has become a public health priority (6). Globally, we have now moved into the era of antimicrobial resistance.