Chapter 4

Mechanisms of Bacterial Resistance to Antimicrobial Agents

Engeline van Duijkeren

Engeline van Duijkeren

Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), BA Bilthoven, The Netherlands, 3720

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Anne-Kathrin Schink

Anne-Kathrin Schink

Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany, 14163

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Marilyn C. Roberts

Marilyn C. Roberts

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, 98195-7234

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Yang Wang

Yang Wang

Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, 100193 Beijing, China

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Stefan Schwarz

Stefan Schwarz

Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany, 14163

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Summary

With regard to their structures and functions, antimicrobial agents represent a highly diverse group of low-molecular-weight substances which interfere with bacterial growth, resulting in either a timely limited growth inhibition (bacteriostatic effect) or the killing of the bacteria (bactericidal effect). For more than 60 years, antimicrobial agents have been used to control bacterial infections in humans, animals, and plants. Nowadays, antimicrobial agents are among the most frequently used therapeutics in human and veterinary medicine (1, 2). In the early days of antimicrobial chemotherapy, antimicrobial resistance was not considered as an important problem, since the numbers of resistant strains were low and a large number of new highly effective antimicrobial agents of different classes were detected. These early antimicrobial agents represented products of the metabolic pathways of soil bacteria (e.g., Streptomyces, Bacillus) or fungi (e.g., Penicillium, Cephalosporium, Pleurotus) (Table 1) and provided their producers with a selective advantage in the fight for resources and the colonization of ecological niches (3). This in turn forced the susceptible bacteria living in close contact with the antimicrobial producers to develop and/or refine mechanisms to circumvent the inhibitory effects of antimicrobial agents. As a consequence, the origins of bacterial resistance to antimicrobial agents can be assumed to be in a time long before the clinical use of these substances. With the elucidation of the chemical structure of the antimicrobial agents, which commonly followed soon after their detection, it was possible not only to produce antimicrobial agents synthetically in larger amounts at lower costs, but also to introduce modifications that altered the pharmacological properties of these substances and occasionally also extended their spectrum of activity.

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