[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]
The Lancet Infectious Diseases, Volume 13, Issue 2, Pages 155 - 165, February 2013
The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria
Prof Elizabeth MH Wellington PhD a, Prof Alistair BA Boxall PhD c, Paul Cross PhD d, Edward J Feil PhD e, William H Gaze PhD f, Prof Peter M Hawkey MD g h, Ashley S Johnson-Rollings PhD a, Davey L Jones PhD d, Nicholas M Lee PhD b, Prof Wilfred Otten PhD j, Prof Christopher M Thomas PhD i, A Prysor Williams PhD d
During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.
a School of Life Sciences, University of Warwick, Coventry, UK; b Institute of Education, University of Warwick, Coventry, UK; c Environment Department, University of York, Heslington, York, UK; d School of Environment, Natural Resources and Geography, Bangor University, Bangor, UK; e Department of Biology and Biochemistry, University of Bath, Claverton Down, Bath, UK; f European Centre for Environment and Human Health, Exeter University Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK: g Health Protection Agency, West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK; h School of Immunity and Infection, University of Birmingham, Edgbaston, Birmingham, UK; i School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK; j The SIMBIOS Centre, University of Abertay Dundee, Dundee, UK
Correspondence to: Prof Elizabeth M H Wellington, School of Life Sciences, University of Warwick, Gibbet Hill Site, Gibbet Hill Road, Coventry CV4 7AL, UK