Table Of ContentCH.DDE.A-R Bacteria.aFM_cx 3/6/08 8:39 AM Page 1
ANTIBIOTIC-
RESISTANT
BACTERIA
CH.DDE.A-R Bacteria.aFM_cx 3/6/08 8:39 AM Page 2
Anthrax Malaria
Antibiotic-resistant Meningitis
Bacteria
Mononucleosis
Avian Flu
Pelvic Inflammatory
Botulism
Disease
Campylobacteriosis
Plague
Cervical Cancer
Polio
Cholera
Prostate Cancer
Ebola
Rabies
Encephalitis
Salmonella
Escherichia coli
Infections SARS
Gonorrhea Smallpox
Hantavirus Pulmonary
Staphylococcus aureus
Syndrome
Infections
Helicobacter pylori
Streptococcus
Hepatitis (Group A)
Herpes Syphilis
HIV/AIDS
Toxic Shock Syndrome
Infectious Fungi
Tuberculosis
Influenza
Tularemia
Legionnaires’ Disease
Typhoid Fever
Leprosy
West Nile Virus
Lyme Disease
Lung Cancer
Mad Cow Disease
(Bovine Spongiform
Encephalopathy)
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ANTIBIOTIC-
RESISTANT
BACTERIA
Patrick G. Guilfoile, Ph.D.
FOUNDING EDITOR
The Late I. Edward Alcamo
Distinguished Teaching Professor of Microbiology,
SUNY Farmingdale
FOREWORD BY
David Heymann
World Health Organization
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Dedicated to Ed Alcamo
Antibiotic-Resistant Bacteria
Copyright © 2007 by Infobase Publishing
All rights reserved.No part ofthis book may be reproduced or utilized in any
form or by any means,electronic or mechanical,including photocopying,
recording,or by any information storage or retrieval systems,without permission
in writing from the publisher.For information contact:
Chelsea House
An imprint ofInfobase Publishing
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ISBN-10:0-7910-9188-0
ISBN-13:978-0-7910-9188-3
Library ofCongress Cataloging-in-Publication Data
Guilfoile,Patrick.
Antibiotic-resistant bacteria / Patrick G.Guilfoile ;consulting editor,
I.Edward Alcamo ;forward by David Heymann.
p.cm.—(Deadly diseases and epidemics)
Includes bibliographical references.
ISBN 0-7910-9188-0 (hc :alk.paper)
1.Drug resistance in microorganisms—Juvenile literature. I.Alcamo,I.
Edward. II.Title.III.Series.
QR177.G85 2006
616.9'041—dc22 2006017589
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CH.DDE.A-R Bacteria.aFM_cx 3/6/08 8:39 AM Page 5
Table of Contents
Foreword
David Heymann, World Health Organization 6
Preface 8
1. What are Antibiotics? 10
2. How Do Antibiotics Kill Bacteria? 22
3. How Do Bacteria Resist Antibiotics? 38
4. Causes of Antibiotic Resistance 58
5. Consequences of Antibiotic Resistance 68
6. The Most Dangerous Antibiotic-
Resistant Bacteria 73
7. Strategies to Combat Antibiotic Resistance 84
8. The Future of Antibiotic Resistance 93
9. Reducing Antibiotic Resistance 100
Glossary 103
Endnotes 108
Bibliography 110
Further Reading 117
Web Sites 118
Index 119
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Foreword
In the 1960s, many of the infectious diseases that had terrorized
generations were tamed. After a century of advances, the leading
killers ofAmericans both young and old were being prevented with
new vaccines or cured with new medicines.The risk ofdeath from
pneumonia, tuberculosis (TB), meningitis, influenza, whooping
cough,and diphtheria declined dramatically.New vaccines lifted the
fear that summer would bring polio,and a global campaign was
on the verge of eradicating smallpox worldwide. New pesticides
like DDT cleared mosquitoes from homes and fields,thus reducing
the incidence of malaria,which was present in the southern United
States and which remains a leading killer of children worldwide.
New technologies produced safe drinking water and removed the
risk of cholera and other water-borne diseases. Science seemed
unstoppable.Disease seemed destined to all but disappear.
But the euphoria ofthe 1960s has evaporated.
The microbes fought back. Those causing diseases like TB
and malaria evolved resistance to cheap and effective drugs.The
mosquito developed the ability to defuse pesticides.New diseases
emerged, including AIDS, Legionnaires’, and Lyme disease. And
diseases which had not been seen in decades re-emerged, as the
hantavirus did in the Navajo Nation in 1993. Technology itself
actually created new health risks. The global transportation
network, for example, meant that diseases like West Nile virus
could spread beyond isolated regions and quickly become global
threats.Even modern public health protections sometimes failed,
as they did in 1993 in Milwaukee,Wisconsin,resulting in 400,000
cases of the digestive system illness cryptosporidiosis. And,
more recently,the threat from smallpox,a disease believed to be
completely eradicated, has returned along with other potential
bioterrorism weapons such as anthrax.
The lesson is that the fight against infectious diseases will
never end.
In our constant struggle against disease,we as individuals have a
weapon that does not require vaccines or drugs,and that is the ware-
house of knowledge. We learn from the history of science that
6
CH.DDE.A-R Bacteria.aFM_cx 3/6/08 8:39 AM Page 7
“modern” beliefs can be wrong. In this series of books, for
example, you will learn that diseases like syphilis were once
thought to be caused by eating potatoes.The invention of the
microscope set science on the right path.There are more posi-
tive lessons from history.For example,smallpox was eliminat-
ed by vaccinating everyone who had come in contact with an
infected person.This “ring”approach to smallpox control is
still the preferred method for confronting an outbreak,
should the disease be intentionally reintroduced.
At the same time,we are constantly adding new drugs,new
vaccines,and new information to the warehouse.Recently,the
entire human genome was decoded.So too was the genome
of the parasite that causes malaria. Perhaps by looking at
the microbe and the victim through the lens of genetics
we will be able to discover new ways to fight malaria,which
remains the leading killer of children in many countries.
Because ofadvances in our understanding ofsuch diseases
as AIDS, entire new classes of antiretroviral drugs have
been developed.But resistance to all these drugs has already
been detected, so we know that AIDS drug development
must continue.
Education, experimentation, and the discoveries that
grow out ofthem are the best tools to protect health.Opening
this book may put you on the path of discovery. I hope so,
because new vaccines,new antibiotics,new technologies,and,
most importantly, new scientists are needed now more than
ever if we are to remain on the winning side of this struggle
against microbes.
David Heymann
Executive Director
Communicable Diseases Section
World Health Organization
Geneva,Switzerland
7
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Preface
Life Before Antibiotics
If you research your family history prior to the 1940s,you are likely
to find some relatives who died,or had a close brush with death,at a
young age.In many cases,those deaths or near deaths resulted from
what were,at the time,untreatable bacterial infections.My personal
family history has an example of the toll bacterial infections took in
the days prior to the development ofantibiotics.
My grandfather, born in 1903, was a robust young man who
grew strong working on the family farm.At the age of 12, he sud-
denly came down with a high fever and a sharp pain in his abdomen.
A trip to the doctor in the back ofa horse-drawn wagon was the clos-
est thing to an ambulance in rural Wisconsin in those days.After a
10-mile ride over rough roads,he arrived at the doctor’s office,where
the doctor confirmed that my grandfather’s appendix had ruptured.
Following another rough ride to the hospital,my grandfather under-
went emergency surgery to remove the offending organ,but he had
already developed a serious bacterial infection in his abdomen.
There was no treatment available aside from bed rest and hope.His
fever by this time was very high,probably over 104°F.The doctor said
his condition was grave; he had less than a 50 percent chance of
pulling through.Obviously,you can guess the end ofthe story,since
I wouldn’t be writing this book if my grandfather hadn’t recovered.
However, one of my grandfather’s brothers wasn’t so lucky. His
appendix had ruptured the previous year,and after a long stay in the
hospital,he ultimately died from a bacterial infection.
Today,we often regard bacterial infections as a minor nuisance,
at worst requiring a trip to the doctor and the pharmacy, but, up
until the 1950s,many bacterial infections were lethal.In fact,people
born in the United States in 1900 had about a 1 percent chance of
dying from infectious disease in a given year. One hundred years
later,that risk was down to 1 percent per 15 years,and a significant
part of that reduced risk of death was due to the availability of
antibiotics.1
Unfortunately, numerous species of bacteria have become
increasingly resistant to antibiotics over the past several decades.
8
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Many scientists, doctors, and healthcare professionals now
wonder if we are returning to a situation where many bacte-
rial infections will be untreatable. This book is designed to
explore that question,and provide some ideas of what indi-
viduals can do to keep that grim scenario from becoming a
reality.
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