Resisting the resistance. Is there progress in maintaining antimicrobial efficacy?

Abstract

(UK) discussed the major health threat caused by multiple drug resistance affecting both human and animal welfare, and the anticipation there will be limited future availability of new antibiotics, particularly in veterinary medicine. She briefly outlined antimicrobial treatment history, from the recognition of the importance of hand hygiene, to the recent golden era of antibiotic availability and efficacy, to the current 'period of disenchantment'; a time when antibiotics are starting to be of limited benefit due to increasing development of resistance.1 She then discussed the main pathogens of concern in human medicine, including Gram-negative organisms, and compared that to current veterinary concerns. In her practice, Vanessa Schmidt sees methicillinresistant Staphylococcus pseudintermedius (MRSP) as the greatest concern, but also methicillin-resistant Staphylococcus aureus and Staphylococcus schleiferi (MRSA and MRSS). Multidrug resistance (MDR) is also emerging in Gram-negative bacteria such as Escherichia coli, Pseudomonas, Proteus, Klebsiella and Acinetobacter spp. from cases of deep pyoderma. Multidrug-resistant enterococci are also becoming a concern.Vanessa Schmidt emphasized that it is important for clinicians to have knowledge of the local and regional antimicrobial resistance situation to help them in empirical clinical decision-making and also to be aware of when an empirical choice would be less appropriate. She presented current data and regional patterns for antimicrobial resistance in the UK. Nationwide data can be accessed online on Pet Resist.a This website provides antimicrobial resistance data from laboratory submissions to IDEXX UK, shown plotted on a map based on where submissions originate. The data lack information indicating from which body regions samples were taken, and on the numbers of isolates the percentages are based upon, but still provide updated information on regional resistance patterns. Data from a study conducted in Liverpool were presented. 2This laboratory-based study analysed S. pseudintermedius data from submissions to the university veterinary laboratory in Liverpool. Bacterial culture results were examined over time, and the site of infection was recorded. The data showed a significant increase in resistance over the past 5 years to clindamycin, gentamicin and fluoroquinolones, as well as MDR. Soft tissueand skin-derived isolates were more resistant than isolates from urine. These results correlated with other studies.3,4 Risk factors for MRSP have been reported to be chronic skin infections, multiple hospital visits and the use of broad-spectrum antibiotics.Oxacillin (methicillin) resistance between 2004 and 2015 was also reviewed in Liverpool. Cases of MRSP, which were first seen in 2007, have since increased year by year. This correlates with international data. The methicillin-sensitive S. pseudintermedius (MSSP) strains showed a high level of clindamycin resistance. The level of resistance to clindamycin in this study was higher when compared to levels reporte...