Six More Questions to Help #3

3. Exactly what is antibiotic resistance?

The term has become so universal — mentioned in more than 2 million Web sites and more than 100,000 medical journal articles — as to pass nearly unquestioned. Yet, according to a team of the world’s leading experts in veterinary pharmacology writing in April’s Journal of Antimicrobial Chemotherapy, there are still too many errors in terminology when scientists — not to mention media and politicians — throw the term around in regard to bacteria from animal sources. Their review of the published literature revealed a number of recurring errors when it comes to methods used to assess resistance, testing quality control, application of the right criteria to interpret the results, and calculation of the drug concentrations necessary to kill specific levels of bacteria. In addition, they noted little consensus on what scientists really mean by the term “multiresistant.”

Definitions of resistant and susceptible become even more confused, they say, when the numbers are applied without understanding whether the discussion concerns how and whether a drug can be expected to work in the field vs. whether the discussion involves cut-off values for the purpose of epidemiological studies. Epidemiological cut-off values, often reported by the media as evidence of public health threats, are determined differently than clinical breakpoints. They may have little or nothing to do with how well a drug can be predicted to work in specific animal species against specific species of bacteria.

“Conducting antibiotic susceptibility testing and subsequent data interpretation is a complex matter,” the authors warn.

Source: Critical Reviews in Microbiology, 31:155–169, 2005

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