Whether we're talking about tuberculosis or any other bacterial infection, whether hospital- or community-acquired, socio-economic inequalities, the disorganization of healthcare systems in certain countries, doctors' lack of knowledge of the basic rules governing the use of antibiotics, and the free circulation of counterfeit products are all factors that affect the efficacy and relevance of the treatments delivered, but are also the cause of the selection and spread of (multi)resistant strains.
The recent emergence of carbapenemases within extended-spectrum beta-lactamases (ESBLs), capable of hydrolyzing the last antibiotics active on Gram-negative bacteria, carbapenems, illustrates the current crisis situation. Originating from environmental micro-organisms in the Indian subcontinent, and having spread within the flora contaminating/infecting man (Klebsielles, Escherichia coli, Acinetobacter), the genes encoding the NDM-1 carbapenemase have spectacularly completed the range of resistance already present in these micro-organisms, making them essentially resistant to all possible antibiotics. The worldwide distribution of bacterial clones carrying NDM-1, and the potential for transmission of the gene itself by interspecies diffusion, due to its presence on easily transmissible genetic elements (plasmids, transposons, integrons), create a formidable situation, and its control highly uncertain. This type of catastrophic emergence can only be prevented at source, through the rational use of antibiotics. Industrially emerging countries with rapidly expanding healthcare systems urgently need to get to grips with this situation.
