The epidemiology of bacterial resistance to antimicrobial agents

Abstract

Infectious diseases have continually played a role in shaping human history. The plague pandemic of the 13th century claimed approximately 25% of the world's population. Dysentery decimated the forces of Napoleon, and tuberculosis, also known as the white plague, condemned many of history's most influential leaders, writers, artists, and scientists to untimely deaths, often in their most productive years. Thus, it was assumed that with the introduction of antimicrobial agents into clinical medicine during the 20th century, the conquest of infectious diseases was likely to be close at hand. Yet, a closer examination of the medical literature beginning in the 1940s reveals an ominous trend that would be repeated over and over again throughout the next several decades: The discovery of virtually every new antimicrobial agent effective against bacteria was followed sooner or later by the recognition of bacterial resistance to the agent. How bacteria develop resistance to antimicrobial agents and how resistant microorganisms spread in hospitals, other health-care settings, and communities will be the focus of this chapter. © Springer Science+Business Media, LLC 2009.