RESISTENCE OF BACTERIA TO
ANTIBIOTICS IN EUROPE
Robert COHEN
Service de Microbiologie, Hôpital Intercommunal de
Créteil, 40 avenue de Verdun - 94010 France
There has been an alarming worldwide increase of
antibiotic resistance among the bacterial pathogens responsible of pediatric
infectious diseases (PID). This is a particular concern in children because of
frequent use of antibiotics for the inpatient setting for life-threatening
infections and in the outpatient setting for common childhood diseases. Fifteen
years ago the antibiotic resistance implicated mainly hospital acquired
pathogens or appeared in some patients with underlying disease e.g. cystic fibrosis,
Immunocompromised patients. The main bacteria involved were Pseudomonas
aeruginosa, Enterobacter, Serratia, meti-R S. aureus. Resistance to
antimicrobials is now an important problem for the bacteria responsible of
community acquired PID; S. pneumoniae, S. pyogenes, H. influenzae for
respiratory tract infections, Salmonella spp, Shigella, Campylobacter jejuni
for gastro intestinal tract infections, E. coli for urinary tract infection.
Everybody knows that inappropriate use of antibiotics is the main responsible
factor for the bacterial resistance problem. However, in many countries the use
of antibiotic is increasing. There are a number of explanations for the
dramatic increase in outpatient antibiotic prescriptions: increase of number of
diagnosis of infectious diseases, access to care for children improved, time
constraints on practitioners and the need to promote consumer satisfaction
(assuming parents want antibiotics). Concerns are not limited to the level of
resistance but also to the multidrug-resistance of some of bacteria implicated
e.g. S. pneumoniae, Salmonella, Shigella and at this time it is probably more
difficult to treat some patients than ten years ago. S. pneumoniae, for
instance, the most common bacterial pathogens for meningitis, bacteremia,
pneumonia, and sinusitis, is increasingly reported around the Europe, as being
resistant simultaneously to penicillins, cephalosporins, macrolides,
tetracyclines, chloramphenicol. The clinical consequences of S. pneumoniae
resistance are demonstrated for meningitis and otitis media, but not for
pneumonia or sinusitis. In Europe, the level of resistance vary from country to
country, schematically the level is low in north European countries and high in
south European countries. The volume of antibiotic use does not always reflect
inappropriate medical prescriptions. Other factors include the
self-administration of antibiotics, as well as the availability of drugs
without prescription for purchase in pharmacies. If antimicrobial usage
contributes importantly to the development of antibiotic resistance, other
factors could play a role: number of children, number and age of patients in
day care centers, type of antibiotic prescribed…
The reversibility of the current situation of
resistance is unknown, actions that could decrease the volume of antibiotic use
without affecting quality of care should be considered. Strategies to limit the
spread of resistant strains should include promoting prudent use of antibiotic.
Guidelines should be based on results derived from well designed clinical
trials and surveillance studies.