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Antibiotics represent arguably one of the greatest achievements of modern medicine. Alexander Fleming not only had the insight to recognize that the mould contaminating his agar plate was producing a potent antibiotic, he also warned in his Nobel Prize acceptance speech of the risk of bacteria developing resistance due to sub-optimal doses of antibiotics.1 In a little over 70 years since the introduction of penicillin, we are now faced with the prospect of a world without effective antibiotics, where patient outcomes in specialties such as oncology, transplant and complex surgery could worsen as minor infections become untreatable.
The convergence of the rapid spread of antimicrobial resistant organisms and the lack of new antibiotics to treat the resulting infections is of global concern.2 The increasing incidence of Gram-negative multi-drug resistant (MDR) pathogens, such as those producing extended-spectrum β-lactamases (ESBLs), has led to a reliance on carbapenems as antibiotics of ‘last-resort’. As a consequence, we have witnessed the emergence of carbapenemase-producing bacteria, resistant not only to carbapenems and other β-lactam antibiotics, but also to aminoglycosides and fluoroquinolones. The situation is exacerbated by the fact that no new classes of antibiotics active against Gram-negative bacteria have been discovered in the last 25 years.
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