Prof Laura Piddock’s team from Birmingham recently published a Nature review on molecular mechanisms of antibiotic resistance. If you’re struggling to tell your KPC from your NDM, this review is for you.
I like the historical perspective, reflecting on the fact that antibiotic resistance pre-dates the discovery of antibiotics in the relatively recent past. Analysis of bacteria trapped in caves and ice identifies antibiotic resistant strains: this is really no surprise since most antibiotics used in human medicine are derived from micro-organisms!
I was struck by the article’s comment on antibacterials v antibiotics, considering them synonymous. For me, antibiotics are a specific sub-set of antibacterial drugs. For example, I wouldn’t consider a β-lactamase inhibitor to be an antibiotic, but I would consider it to be an antibacterial!
The review covers the various intrinsic mechanisms of resistance (with some excellent figures by the way) but spends most of its time on acquired mechanisms, especially the β-lactamases. The story is really one of microbial Tom and Jerry. The emergence of early β-lactamases prompted the development of the extended spectrum β-lactams, but extended spectrum β-lactamases (ESBLs) soon followed. Carbapenems overcame ESBLs, but carbapenemases soon followed. And this is where we are today: Tom never does catch Jerry, and nor will we ever really catch up with antibiotic resistance!