Moyens de défense des bactéries.

Details

Serval ID
serval:BIB_BD447075E4C8
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Moyens de défense des bactéries.
Journal
Revue Médicale de la Suisse Romande
Author(s)
Moreillon P.
ISSN
0035-3655 (Print)
ISSN-L
0035-3655
Publication state
Published
Issued date
2000
Volume
120
Number
8
Pages
641-650
Language
french
Abstract
Fifty years ago, the introduction of penicillin, followed by many other antibacterial agents, represented an often underestimated medical revolution. Indeed, until that time, bacterial infections were the prime cause of mortality, especially in children and elderly patients. The discovery of numerous new substances and their development on an industrial scale confronted us with the illusion that bacterial infections were all but vanquished. However, the widespread and sometimes uncontrolled usage of these agents has led to the selection of bacteria resistant to practically all available antibiotics. Bacteria utilize three main resistance strategies: (i) decrease in drug accumulation, (ii) modification of target, and (iii) modification of the antibiotic. Bacteria can decrease drug accumulation either by becoming impermeable to antibiotics, or by actively excreting the drug accumulated in the cell. As an alternative, they can modify the structure of the antibiotic's molecular target--usually an essential metabolic enzyme of the bacteria--and thus escape the drug's toxic effect. Lastly, they can produce enzymes capable of modifying and directly inactivating the antibiotics. In addition, bacteria have evolved extremely efficient genetic transfer systems capable of exchanging and accumulating resistance genes. Some pathogens, such as methicillin-resistant Staphylococcus aureus and enterococci are now resistant to almost all available antibiotics. Vancomycin is the only non-experimental drug left to treat severe infections due to such organisms. However, vancomycin resistance has already appeared several years ago in enterococci, and was also recently described in staphylococci, in Japan, France and the United-States. Antibiotics are precious drugs which must be administered to patients who need them. On the other hand, the development of resistance must be kept under control by a better comprehension of its mechanisms and modes of transmission and by abiding by the fundamental rules of anti-infectious chemotherapy, i.e.: (i) choose the most efficient antibiotic according to clinical and local epidemiological data, (ii) target the bacteria according to the microbiological data at hand, and (iii) administer the antibiotic at an adequate dose which will leave the pathogen no chance to develop any resistance.
Keywords
Anti-Bacterial Agents/pharmacology, Anti-Bacterial Agents/therapeutic use, Bacterial Physiological Phenomena/drug effects, Cell Membrane Permeability/drug effects, Cell Membrane Permeability/physiology, Drug Resistance, Microbial/physiology, Humans, Patient Selection, R Factors/drug effects, R Factors/physiology
Pubmed
Create date
24/01/2008 14:57
Last modification date
20/08/2019 16:31
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