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The problem of resistance 

The problem of resistance
The problem of resistance

Peter Davey

, Mark Wilcox

, William Irving

, and Guy Thwaites

Page of

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date: 18 April 2021

This chapter deals with the crucial issue of resistance to antimicrobial agents. The types of resistance (acquired versus intrinsic) are reviewed, including historical and present-day key exemplars of pathogens with acquired resistance. The mechanisms underlying acquired resistance are examined. The clinical consequences of drug resistance are discussed using examples of prominent pathogens, including enteric Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae), acinetobacter, staphylococci (MRSA) and glycopeptide-resistant enterococci, Neisseria gonorrhoeae and Mycobacterium tuberculosis. The most alarming examples of multidrug-resistant pathogens are carbapenemase-producing enterobacteria, given the ‘last line of defence’ status of the carbapenems, and M. tuberculosis strains that emerge particularly when optimized treatment courses are not followed.

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