As multidrug resistance (Latin compositum) is called in medicine a form of antibiotic or antiviral drug resistance in the so-called germs (bacteria or viruses) against several different / almost (almost) all antibiotics or antivirals are insensitive. They are also referred to as MRE germs / Multi-drug resistant pathogens.
Multidrug resistance of bacteria to antibiotics in medicine is an ever increasing problem dar. There are various causes that lead to an increase in multi-drug resistance.
Frequent often unnecessary use of antibiotics
There are prescribed for viral infections, even though they do not help here antibiotics. This leads to more frequent contact of possible pathogens with antibiotics. By natural random mutations against antibiotic-resistant bacteria are now used to over the non-resistant strains of bacteria multiply faster and better maintain and end up so well in the environment.
Use of antibiotics in the food industry
Here are frequently mixed with antibiotics to animal feed in order to increase the yield. Many of these are related to the antibiotics used in human medicine. This can in turn develop resistant strains of bacteria that can cause problems in human medicine.
Not just test or indication equitable use of antibiotics
It is highly effective so-called broad-spectrum antibiotics are often used for bacterial infections, in which, for example, penicillin is still effective. Due to this widespread use of highly effective antibiotics, the selection of multiresistant bacteria is promoted again. In case of emergency later this highly effective drug is possibly no longer effective.
Unreliable medication (compliance) of the patients
Characterized agents are only partially destroyed, the surviving bacteria or viruses are often those with a higher natural resistance. These genes will be passed on to future generations, so that the next use of the same drug no more success is achieved.
Special case: HIV Therapy
As a cure for diseases with HIV virus is not yet possible, a life-long treatment with antivirals is been necessary. Early on it was discovered that the monotherapy (only one drug) is not effective for long. The HI-virus is rapidly in a position to be resistant to the drug. Therefore, given the beginning of a multiple combination, so that the probability of developing resistance is reduced. Nevertheless, it often occurs during the treatment of multidrug resistance development. There are therefore constantly developing new drugs.
Multidrug-resistant strains of problem
An article in the journal “The Lancet”, according, were discovered worldwide bacterial strains with the NDM-1 (New Delhi metallo-β-lactamase 1) designated gene, which are against all known antibiotics except tigecycline and colistin, be resistant . The gene is not yet surfaced in the Gram-negative enteric bacteria Escherichia coli and Klebsiella pneumoniae and especially common in India and Pakistan. There are cases in the UK, the Netherlands, Australia and Sweden have also been discovered, often after surgery (especially plastic surgery) in the former Asian countries.
Methicillin-resistant Staphylococcus aureus (MRSA) strains
Since 1963 Staphylococcus aureus strains are described which have a mutation in their penicillin-binding protein II (PBP II) and therefore against all beta-lactam antibiotics (including, but against so-called beta-lactamase-resistant AB: methicillin, oxacillin, Others flucloxacillin called staphylococcal antibiotics) are resistant. If they also have a resistance to other classes of drugs, few preparations for the treatment (eg, glycopeptides, such as vancomycin or teicoplanin or newer and more expensive drugs, such as from the class of oxazolidinone linezolid or tigecycline from the class of glycylcyclines) are used . MRSA are now found worldwide and are mainly used in intensive care to a growing problem. Thus, the incidence of disease (incidence) in intensive care units in the United States is already> 50%, in France and Southern Europe> 30%. In Germany, the incidence is in hospital at around 15 to 20%, but is subject to large regional variations. Also at approximately 2.5% of all residents of nursing homes MRSA can be isolated. Like other S. aureus strains can also occur in germ MRSA colonization of the nose and throat, without the patient ill. This results in germ reservoirs, which can infect other immunocompromised patients. Especially dangerous are germ settlements with hospital staff, since a continuous risk of infection in patients with immunodeficiency (eg open wounds, intravascular catheters, dialysis, or artificial respiration) is given.
Vancomycin-intermediate-sensitive Staphylococcus aureus (VISA) strains
For several years occur in Japan MRSA strains that are intermediately sensitive also to glycopeptides. Individual cases have occurred in the United States, France, Hong Kong and Thailand. It is likely that these strains are also spreading.
Vancomycin-resistant Staphylococcus aureus (VRSA) strains
Of actually vancomycin-resistant S. aureus (VRSA) have only been very few cases described in the U.S.. They are unlike the VISA strains characterized by the fact that they have the the glycopeptide resistance coding, from vancomycin / glycopeptide-resistant enterococci (VRE / GRE) originating vanA gene.
Extended-spectrum ß-lactamase-producing pathogens
Extended-spectrum β-lactamase (ESBL) producing pathogens are bacteria, which are represented by a point mutation within the β-lactamase enzyme expressed genes is now able to produce the extended-spectrum β-lactamase. This altered enzyme, a larger range of β-lactam antibiotics containing columns. ESBL-carrying bacteria are therefore resistant to penicillins, cephalosporins (generation 1-4) and against monobactams. Mainly E. coli and Klebsiella (Gram negative bacteria) have ESBL genes.