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The emergence of huge population centers, with 10 to 20 million inhabitants in large cities without adequate hygiene and sanitation, has been described as a time bomb for emergence of new infectious diseases. As a counterpoint to newly emerging bacterial pathogens is the increase in known pathogens with new arsenals of drug resistance. While hospitals are clearly fertile arenas for selection of antibiotic-resistant pathogenic bacteria, a complementary arena that has been understood for decades is the use of antibiotics in animal feed, for growth promotion and infectious disease prophylaxis. It has been noted that Clostridium difficile overgrowth has led to restrictions on cephalosporin use in certain geriatric populations and that extensive use of cephalosporins in the 1980s played a significant part in the emergence and spread of Methicillin-resistant S. aureus (MRSA) in London and in Tokyo hospitals as well as the selection for Escherichia coli and Enterobacter cloacae strains with many mutational variants of the plasmid-encoded β-lactamases. Increased molecular knowledge about essential bacterial genes and the ability to screen such validated targets with libraries of new synthetic and natural products are likely to turn up new antibiotics against nontraditional bacterial targets. But new antibiotic molecules by themselves will not alter the kinetics of the cycles of resistance development.
Antibiotic resistance phenotypes of multidrug-resistant Salmonella enteric serovar typhimurium DT104.
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