Is there a terrible issue with bacterial resistance: pro–con

Abstract

We are observing a major increase in antibiotic resistance of many bacterial species, Klebsiella pneumoniae and Acinetobacter baumannii in particular [1]. This triggers an alarmist response in major journals in the world, the WHO and the CDC [2]. It is clear that the response of the media and governments to ongoing events is not always rational and often leads to overreactions. Hence, very few of the virus or prion alerts in last 30 years have been confirmed, including bioterrorism, avian flu, ‘Mad cow’ disease, severe acute respiratory syndrome, Middle East respiratory syndrome, coronavirus and the globalized threat of Ebola which has been predicted since 1976 [3]. In this context, wemust carefully appraise alerts on antibiotic resistance to avoid overreacting. Indeed, in the 1970s, the end of the antibiotic era had already been predicted at the time of the emergence of resistance in Serratia marcescens [4]. It is important to balance correctly the burden of disease, because this impacts drug development, drug agencies’ approval thresholds for new drugs, allocation of research funds and more. The medical literature draws attention to bacteria becoming resistant but neglects bacteria becoming susceptible. For example Staphylococcus aureus, which is perhaps the biggest bacterial killer in developed countries, is less resistant now than 10 years ago in most of the countries worldwide [5], and in Marseille there is three times less methicillin-resistant S. aureus now as there was 10 years ago [6]. The sum of bacteria that became less resistant and bacteria that became more resistant in the last 15 years in Marseille does not suggest that the problem of resistance has worsened [6]. Susceptibilities to old antibiotics such as trimethoprim-sulfamethoxazole in S. aureus and chloramphenicol or aminoglycosides in Gram-negative bacteria in hospitals is increasing with time in many hospitals. Moreover, community-acquired bacteria such as Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae