Abstract
The emergence of clinical isolates associated to multidrug resistance is a serious threat worldwide in terms of public health since complicates the success of the antibiotic treatment and the resolution of the infectious process. This is of great concern in pathogens affecting the lower respiratory tract as these infections are one of the major causes of mortality in children and adults. In most cases where the respiratory pathogen is associated to multidrug-resistance, antimicrobial concentrations both in serum and at the site of infection may be insufficient and the resolution of the infection depends on the interaction of the invading pathogen with the host immune response. The outcome of these infections largely depends on the susceptibility of the pathogen to the antibiotic treatment, although the humoral and cellular immune responses also play an important role in this process. Hence, prophylactic measures or even immunotherapy are alternatives against these multi-resistant pathogens. In this sense, specific antibodies and antibiotics may act concomitantly against the respiratory pathogen. Alteration of cell surface structures by antimicrobial drugs even at sub-inhibitory concentrations might result in greater exposure of microbial ligands that are normally hidden or hardly exposed. This alteration of the bacterial envelope may stimulate opsonization by natural and/or specific antibodies or even by host defense components, increasing the recognition of the microbial pathogen by circulating phagocytes. In this review we will explain the most relevant studies, where vaccination or the use of monoclonal antibodies in combination with antimicrobial treatment has demonstrated to be an alternative strategy to overcome the impact of multidrug resistance in respiratory pathogens.
Highlights
One third of the annual deaths occurring in the world are estimated to be due to infectious diseases and notably, infections affecting the respiratory tract are responsible of 4 million deaths worldwide [1]
In the last decade of XX century, therapies based in antibodies to treat these infections were commonly used [8] and, in the 20’s of last century, serum therapy was used against many bacterial diseases including infections affecting the respiratory tract, such as those caused by S. pneumoniae [9]
A different approach to reduce the burden of disease caused by multidrug resistant (MDR) pathogens and limit the dissemination of resistance genes is based in the implementation of effective vaccines with high coverage rates among the pediatric and adult population [12, 13]
Summary
One third of the annual deaths occurring in the world are estimated to be due to infectious diseases and notably, infections affecting the respiratory tract are responsible of 4 million deaths worldwide [1]. In the last decade of XX century, therapies based in antibodies to treat these infections were commonly used [8] and, in the 20’s of last century, serum therapy was used against many bacterial diseases including infections affecting the respiratory tract, such as those caused by S. pneumoniae [9]. These treatments reduced in a 50%, the mortality caused by this pathogen [10]. A different approach to reduce the burden of disease caused by MDR pathogens and limit the dissemination of resistance genes is based in the implementation of effective vaccines with high coverage rates among the pediatric and adult population [12, 13]
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