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Antibiotic-resistant pathogens—epidemiology and clinical relevance

In the early days of antibiotic development, penicillin, sulfa, and early macrolide antibiotics were the mainstay of antimicrobial therapy. At this time Gram-positive pathogens were of major concern. With the advent of methicillin and vancomycin in the 1960s, Gram-positive pathogens were considered to be less of a problem. The focus on treating Gram-negative pathogens began in the 1970s. Thus, in the 1980s, the pharmaceutical industry concentrated antibiotic development efforts on treating these pathogens. The antibiotics developed were described as “broad spectrum” and covered far more than the original target organisms. The culture moved from one of treating not only Gram-positive organisms, but to treating enteric and nosocomial Gram-negative organisms. Over time, it has become clear that use of broadspectrum antibiotics (advanced-generation cephalosporins, fluoroquinolones, and advanced-generation macrolides) has placed selective pressure on antimicrobial flora. This selected pressure has presented new challenges in antibiotic resistance in both Gram-positive and Gram-negative organisms.