Microbial defense mechanisms : antibiotic resistance, THE challenge (2)

The projections are worrying. Without a radical change in the current momentum of the antibiotic resistance epidemic, mortality from infectious diseases is set to become the leading cause of death on the planet by 2050. From a problem largely confined to hospitals, antibiotic resistance has become an ecological problem of global proportions. A typical example is the sustained appearance and uncontrolled spread of carbapenemases. Carbapenem resistance concerns Gram-negative bacteria: enterobacteria(E. coli, Klebsiella), Pseudomonas and Acinetobacter. It is most prevalent in hospital-acquired infections, and has become a worldwide crisis in the last ten years, even spreading outside hospitals. Its spread is rapid, thanks to versatile genetic carriers combining integrons, transposons and plasmids carrying multiple resistances to other antibiotics and antiseptics. The only alternative therapeutic resource is an old antibiotic: colistin, but plasmid-borne resistance has just emerged in China in poultry and cattle farms, where this antibiotic is used massively and uncontrolled. The antibiotic war is being lost. We urgently need to develop innovative approaches to specifically eliminate bacteria carrying carbapenemases and other critical resistances, and even to excise resistance genes precisely. A new world of infectious diseases is opening up, with a major crisis that must be addressed as a matter of priority.