Antimicrobial Resistance: A Crisis in Health Care PDF
Preview Antimicrobial Resistance: A Crisis in Health Care
ANTIMICROBIAL RESISTANCE A Crisis in Health Care ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY Editorial Board: NATHAN BACK, Swte University of New York at Buffalo !RUN R. COHEN, The Weizmann Institute of Science DAVID KRITCHEVSKY, Wistar Institute ABEL LAJTHA, N. S. Kline Institute for Psychiatric Research RODOLFO PAOLETTI, University of" Milan Recent Volumes in this Series Volume 385 MUSCLE, MATRIX, AND BLADDER FUNCTION Edited by Stephen A. Zderic Volume 386 INHIBITORS TO COAGULATION FACTORS Edited by Louis M. Aledort, Leon W. Hoyer, Jeanne M. Lusher, Howard M. Reisner, and Gilbert C. White II Volume 387 BIOLOGICAL REACTIVE INTERMEDIATES V: Basic Mechanistic Research in Toxicology and Human Risk Assessment Edited by Robert Snyder, I. Glenn Sipes, George F. Kalf, David J. Jollow, Helmut Greim, James J. Kocsis, Terrence J. Monks, and Charlotte M. Witmer Volume 388 OXYGEN TRANSPORT TO TISSUE XVII Edited by C. !nee, J. Kesecioglu, L. Telci, and K. Akpir Volume 389 INTRACELLULAR PROTEIN CATABOLISM Edited by Koichi Suzuki and Judith S. Bond Volume 390 ANTIMICROBIAL RESISTANCE: A Crisis in Health Care Edited by Donald L. Jungkind, Joel E. Mortensen, HenryS. Fraimow, and Gary B. Calandra Volume 391 NATURAL TOXINS 2: Structure, Mechanism of Action, and Detection Edited by Bal Ram Singh and Anthony T. Tu Volume 392 FUMONISINS IN FOOD Edited by LaurenS. Jackson, Jonathan W DeVries, and Lloyd B. Rullerman Volume 393 MODELING AND CONTROL OF VENTILATION Edited by Stephen J. G. Semple, Lewis Adams, and Brian J. Whipp A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. ANTIMICROBIAL RESISTANCE A Crisis in Health Care Edited by Donald L. Jungkind Thomas Jefferson University Hospital Philadelphia, Pennsylvania Joel E. Mortensen St. Christopher's Hospital for Children Philadelphia, Pennsylvania Henry S. Fraimow The Graduate Hospital Philadelphia, Pennsylvania and Gary B. Calandra Merck Research Laboratories West Point, Pennsylvania SPRINGER SCIENCE+BUSINESS MEDIA, LLC Llbrary of Congress Catalog1ng-1n-Pub11cat1on Data Antimicrobial reststance a crisis in health care I edited by Donald L. Jungk 1nd ... [et a I. J. p. cm. -- CAdvances in experimental medicine and blology ; v. 390) ''Based an the proceedings of the Eastern Pennsylvania Branch of the American Soc1ety of Microb1ology Sympos1um an Antlmicrobial Res1stance: a Crisls 1n Healthcare--Cilnlcal Labaratory and Epidemiologie Considerations. held November 11-12, 1993 in Philadelphia, Pennsylvania"--T.p. verso. Includes bibliograph1cal references and Index. ISBN 978-1-4757-9205-8 ISBN 978-1-4757-9203-4 (eBook) DOI 10.1007/978-1-4757-9203-4 1. Antibiotics--Congresses. 2. Drug res1stance 1n m1croorgan1sms- -Congresses. I. Jungkind, Donald L. II. Eastern Pennsylvania Branch of the American Saciety of Microblology Symposium an Antimicrabial Resistance: a Crisis in Healthcare--Clinical Labaratory and Epidem1o1og1c Considerations <1993 Philadelphia, Pa. l III. Series. [ONLM: 1. Drug Resistance. Microbial--congresses. 2. Streptococcal Infectians--drug therapy--congresses. W1 AD559 v.390 1995 I QW 52 A6313 1995] RM267.A556 1995 616' . o1 --dc20 DNLM/DLC far Library af Congress 95-48271 CIP Basedon the proceedings of the Eastern Pennsylvania Branch of the American Society of Microbiology Symposium on Antimicrobial Resistance: A Crisis in Healthcare-Clinical Laboratory and Epidemiologie Considerations, held November 11-12, 1993, in Philadelphia, Pennsylvania ISBN 978-1-4757-9205-8 © 1995 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1995 Softcoverreprint ofthe hardcoverIst edition 1995 10987654321 All rights reserved No part ofthis book may be reproduced, stored in a retrieval system, or Iransmitted in any form or by any means, electronic, mechanical, photocopying. microfilming, rccording, or otherwise, without written permission from the Publisher DEDICATIONS Donald L. Jungkind dedicates his contributions to his wife Kim, to his parents, and to George Wren, Robert C. Wood, and Gerald Shockman, who were influential in his education in science and antimicrobial agents. Henry S. Fraimow dedicates his contributions to his wife Jacqueline French, to his children, Benjamin and Rebecca, and to Michael Miller. Joel E. Mortensen dedicates his contributions to the staff of the Clinical Microbiology Laboratory at St. Christopher's Hospital for Children, and to his son Jonathan. Dr. Gary B. Calandra dedicates his contributions to his wife Kathie and to his son John. GENEROUS SUPPORT FOR THE SYMPOSIUM THAT WAS THE BASIS FOR TmS PUBLICATION WAS PROVIDED BY Sponsoring Organization Eastern Pennsylvania Branch of the American Society for Microbiology Corporate Sponsors Lederle Laboratortes Merck, Inc. Miles Pharmaceuticals Pfizer Roertg Division MetPath Becton-Dickinson Pfizer Laboratortes Ortho Pharmaceuticals Remel Microbiology Products Baxter-Micro scan Academic Sponsors Pennsylvania Department of Health Gwynedd-Mercy College Hahnemann University National Laboratory Training Network Pennsylvania College of Podiatrtc Medicine Philadelphia College of Osteopathic Medicine St. Chrtstopher's Hospital Temple University School of Medicine Thomas Jefferson University University of Pennsylvania PREFACE Development and Implications of Antimicrobial Resistance One of the most ominous trends in the field of antimicrobial chemotherapy over the past decade has been the increasing pace of development of antimicrobial resistance among microbial pathogens. The hypothesis that man can discover a magic bullet to always cure a particular infection has proved false. Physicians are now seeing and treating patients for which there are few therapeutic alternatives, and in some cases, none at all. Until recently there was little concern that physicians might be losing the war in our ability to compete with the evolving resistance patterns of microbial pathogens. Now the general public is very aware of the threat to them if they become infected, thanks to cover story articles in major magazines such as Time, Newsweek, newspapers, and other news sources. Antimicrobial resistance is not a novel problem. Shortly after the widespread introduction of penicillin in the early 1940s, the first strains of penicillin-resistant staphylococci were described. Today it is an uncommon event for a clinical laboratory to isolate an S. aureus that is sensitive to penicillin. Other gram-positive strains of bacteria have become resistant, including the exquisitely sensitive Streptococcus pneumoniae. Sensitivity to vancomycin was once so uniform that it was used in routine clinical laboratories as a surrogate marker for whether an organism should be classified as a gram-positive. That criterion can no longer be relied upon because of emerging resistance among some species. Gram-negative bacteria, viruses, fungi, and parasites all have succeeded in developing resistance. The worldwide pharmaceutical industry has created more than 50 penicillins, 70 cephalosporins, 12 tetracyclines, 8 aminoglycosides, and multiple quinolones, monobactams, carbepenems, macrolides, and dihydrofolate reductase inhibitors. Despite all of these agents, patients still succumb to bacterial infections caused by bacterial strains that have learned to beat the antibiotics. The origins of the current crisis in antimicrobial resistance are complex and may differ somewhat for nosocomial and community-acquired pathogens and for highly developed and underdeveloped countries. However, resistance should be considered the natural consequence of microorganisms responding to the selective pressures of antimicrobial agents, and this process will continue to occur as long as antimicrobial agents are in use. The consequences of increasing resistance are enormous. Resistance leads to increased morbidity and mortality, the need to use more toxic and Vii expensive therapies, and to expend ever greater resources on monitoring and surveillance, all at a time when resources for health care are becoming more limited. We need to understand how resistance develops, how it spreads, how the practice of medicine affects resistance, and respond to this threat before we return to a preantibiotic era of medicine. This process will require the cooperation of physicians, researches, public health officials, the pharmaceutical industry, the food industry, and the cooperation of governments throughout the world, to win against, or at least keep pace with, an increasingly complex population of microbes. This symposium was organized to bring together physicians, researchers, microbiologists, and laboratorians with recognized experts in the field of antimicrobial resistance to further the understanding of this complex issue. The presenters of this symposium have highlighted varied aspects of the problem. Most importantly they have, in key areas, given direction to address the problems associated with antimicrobial resistance, with immediate action steps and future research. In the months since the symposium presentations, the chapters for this book were written, reviewed, and updated as necessary, to insure that the information is timely and relevant. We hope the papers will stimulate further action by the readers. ACKNOWLEDGMENT. The editors wish to thank Paul R. Jaselskis for his patience and tireless efforts in the administrative preparation of these manuscripts. His influence is evident throughout the book. A big ''Thanks," Paul! Donald L. Jungkind Henry S. Fraimow Joel E. Mortensen Gary B. Calandra viii CONTENTS Antimicrobial Resistance: A Global Perspective 1 STUART B. LEVY Resistance to Antibacterial Agents. . . . . . . . . . . . . . . . . . . . . . . . 15 CHRISTINE C. SANDERS and W. EUGENE SANDERS, JR. Bacterial Resistance to Carbapenems . . . . . . . . . . . . . . . . . . . . . . 25 DAVID M. LIVERMORE Bacterial Resistance to Fluoroquinolones: Mechanisms and Patterns ............................................ 49 DAVID C. HOOPER A Comparison of Active Site Binding of 4-Quinolones and Novel Flavone Gyrase Inhibitors to DNA Gyrase . . . . . . . . . . . . . . . . . . . 59 J.J. HILLIARD, H.M. KRAUSE, J.I. BERNSTEIN, J.A. FERNANDEZ, V. NGUYEN, K.A. OHEMENG, and J.F. BARRETT A Low-Copy Number Plasmid Mediating f3-Lactamase Production by Xanthomonas maltophilia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 MICHAEL D. KELLY and JOEL E. MORTENSEN Glycopeptide Resistance in Gram-Positive Pathogens. . . . . . . . . . 81 HENRYS. FRAIMOW and DAVID M. SHLAES Vancomycin-Dependent Enterococci: A Clinical and Laboratory Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 HENRY S. FRAIMOW and DONALD L. JUNGKIND Streptococcus pyogenes: Resistant. Tolerant, Neither or Both? . . . 109 JOEL E. MORTENSEN and THOMAS MCDOWELL The Antimicrobial Susceptibility of Streptococcus pyogenes Isolates from the Philadelphia Area. . . . . . . . . . . . . . . . . . . . . . . . 119 ANTHONY L. FERRARO, JOEL E. MORTENSEN, DEBORAH L. BLECKER,andCHANHPHENGPHENGVATH Antibiotic-Resistance in Streptococcus pneumoniae. . . . . . . . . . . 123 KAREN KRISHER ix
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