H. Anwar, J. Strap, J. Costerton
Jul 1, 1992
Citations
12
Influential Citations
403
Citations
Quality indicators
Journal
Antimicrobial Agents and Chemotherapy
Abstract
Few discoveries in the history of medicine have had such a profound impact on human life and society as the discovery of antibiotics to combat bacterial infections. In the last few decades, there has been an observed exponential increase in the number of antibacterial compounds with diverse chemical structures introduced clinically to control infectious diseases. The most significant development in antibiotic research has been the ability to extend and improve the action of naturally occurring compounds by chemical modification. An example of this is the chemical modification of the penicillin molecule such that the new derivatives are immune to attack by bacterial enzymes (e.g., ,B-lactamases). Despite efforts in the search for new antibiotics as well as the improvement of existing antibiotic performance, bacterial resistance to antimicrobial agents remains a problem in the treatment of infections. Before a new antibiotic is introduced into clinical practice, extensive laboratory studies are performed to prove that the new compound is superior to existing compounds in killing the many species of pathogens for which the antibiotic is intended. These species of pathogens, which are grown planktonically in test tubes, are often used to test the effectiveness of the compound in their eradication. If the results are promising, then carefully designed in vivo animal models and clinical trials are used to obtain data regarding the efficacy of the compound. Undoubtedly, this approach has been extremely successful, and many new antibiotics are introduced into clinical practice annually. However, resistance to the antibiotic may be detected soon after its release for clinical use. We believe that this is partly due to the inadvertent use of sublethal concentrations of antibiotics in the treatment of chronic infections such as medical device-related infections. It is therefore of great importance to consider the strategies that are being used to deal with medical device-related infections. It is hoped that this minireview will help to stimulate the formulation of effective strategies to combat these chronic infections.