Book Reviews

Antimicrobial Resistance

Beyond the Breakpoint

J. T. Weber (ed.). Vol. 6 of “Issues in Infectious Diseases”, B. W. J. Mahy (ed.). Karger Publishers, Basel (2010). ISBN 978-3-8055-9323-6, ISSN 1660-1890. X+ 174 pages, 4 figures, 18 tables, hard cover. EUR 135.00; CHF 189.00; USD 189.00.

The monography deals with one of the most important topics of antimicrobial chemotherapy – antimicrobial resistance.

Antimicrobial agents have saved countless lives and eased the suffering of millions of people over many decades. A powerful and uncomplicated weapon in medicine in the early to middle second half of the last century. Unfortunately, by the end of the last century we have seen the emergence and spread of micro-organisms that have acquired resistance to almost all classes of antibiotics mostly induced by inappropriate widespread and often unreflected use. The consequences of infections due to these antibiotic-resistant microbes even led to reservations of informed patients to enter hospitals, since it is known by the informed public that medical facilities are often sources for the acquisition of infections due to multi-resistant pathogens. A fatal world-wide condition which is perfectly specified within this book also considering the full scale of costs of antimicrobial resistance to society, both in human and economic terms.

The chapters of the book are listed below for a better information:

Community-Associated Methicillin Resistant Staphylococcus aureus (Miller LG); Infections with Organisms Producing rExtended-Spectrum β-Lactamase (Paterson DL et al.); Fluoroquinolone Resistance: Challenges for Disease Control (Parry CM); Antibiotic Resistance and Community-Acquired Pneumonia during an Influenza Pandemic (Moore MR et al.); Promoting Appropriate Antimicrobial Drug Use in the Outpatient Setting: What Works? (Belongia EA et al.); Reducing Antimicrobial-Resistant Infections in Health Care Setting: What Works? (Rezai K et al.); Cost of Antimicrobial Resistance in Healthcare Settings: A Critical Review (Merz LR et al.); Mass Treatment of Parasitic Disease: Implications for the Development and Spread of Anthelmintic Resistance (Churcher TS et al.); Antifungal Drug Resistance: Clinical Importance, in vitro Detection and Implications for Prophylaxis and Treatment (Arthington-Skaggs BA et al.); Preparing for HIV Drug Resistance in the Developing World (Bennett DE).

This monography reports on a broad range of topics in antimicrobial resistance that deeply go beyond aspects such as established definitions and data from microbiological antimicrobial sustainability assessment. Socio-economical burdens associated with antimicrobial resistance target the central messages of this book. Beside basic microbiological information, the main focus of this book is on evidence for effective therapeutic interventions, costs and treatment regimens, and new important corresponding issues are specified and highlighted where information is ambiguous and/ or lacking.

The chapters are written by internationally recognized experts and opinion leaders within the corresponding fields. Each chapter gives a brief introduction concerning its background and then examines the evidence for an important aspect such as e.g. prevention, disease control, treatment strategies or policy decisions combined with socio-economical considerations. Especially prevention and control strategies are critically analyzed for e. g. insufficient use of antimicrobial agents, fluoroquinolone-resistant organisms, healthcare associated infections and parasitic or fungal diseases. Additionally, treatment strategies for rapidly changing resistance patterns are explored for diseases such as community-acquired pneumonia during influenza pandemia and infections with community-associated methicillin resistant Staphylococcus aureus, extended-spectrum β-lactamase producing organisms and fungi.

Aspects for rationals for proper policy making are discussed in some contributions that detail the costs of infections due to antimicrobial resistant organisms, e.g. in healthcare settings. Also the threat of antimicrobial resistance prevalence and development due to the introduction of antiretroviral therapy for large HIV-positive populations in the developing world is properly addressed.

Many of these socio-economical issues concerning infectious diseases change rapidly and steadily due to changing resistance patterns and/or other epidemiological backgrounds. In these cases the reviews indicate where interventions, surveillance and research will be most useful for managing the ubiquitous problems of antimicrobial resistance now and for the future.

In conclusion, this monography is an important contribution for physicians and anybody dealing with infectious diseases as well as for e. g. public health officials interested in the prevention of antimicrobial resistant infections and/ or are in charge of these issues where the “journey” concerning antimicrobial resistance will go along. An excellent book on an important topic for a reasonable prize.

Axel Schmidt, Witten/Herdecke