Bacterial resistance to antimicrobial agents: selected problems in France, 1996 to 1998.

Update Dr. Aubry-Damon is a microbiologist specializing in antimicrobial resistance at the National Institute for Public Health Surveillance, Saint-Maurice, France. The institute has recently carried out an exploratory study of a national program for surveillance of antimicrobial resistance in France. Dr. Aubry-Damon also collaborates closely with the French National Reference Center for Antibiotics. (No photo available) Dr. Courvalin is professor at the Institut Pasteur, where he directs the French National Reference Center for Antibiotics and heads the Antibacterial Agents Unit. Dr. Courvalin specializes in the genetics and biochemistry of antibiotic resistance. His research has led to revision of the description of the natural dissemination of antibiotic resistance genes. His laboratory demonstrated that pathogenic bacteria can promiscuously exchange genetic material conferring antibiotic resistance, documented that conjugation could account for dissemination of resistance determinants between phylogenetically remote bacterial genera, elucidated the transposition mechanism of conjugative transposons from gram-positive cocci, and recently, obtained direct gene transfer from bacteria to mammalian cells. Surveillance of antibiotic resistance in human pathogens has long been performed in France. Existing surveillance relies on national reference centers dedicated to various bacterial genera and on networks of volunteer medical microbiologists, mainly in general hospitals but also in private laboratories. Regional data (often initiated at the request of and funded by the pharmaceutical industry) have been available since the early 1950s. Because of the major health problems caused by antibiotic resistance in the last few years, attempts have been made to organize a national surveillance program similar to those being established in other European countries. Although this update reviews recent data from France, the representativeness of the data has not been assessed. In addition, these are raw data, and their clinical importance remains to be seen; for example, the contribution of bacterial isolates to infection or colonization is, in most instances, unknown. Dissemination of β β β β β-Lactamases in Gram-Negative Bacilli In France, β-lactamases and fluoroquinolones are the most frequently prescribed antibiotics in Enterobacteriaceae infections. A multicenter study (14 hospitals) across the country analyzed the antibiotic susceptibility of 2,507 and 2,312 consecutive, nonrepetitive enterobacteria responsible for infection in 1996 and 1997, respectively (1,2). Strains were isolated from inpatients (86%) in intensive care (ICU) (12%), surgical (17%), medical (37%), and geriatric (9%) units. The majority of isolates were from urine (71%), pus (9%), and bronchopulmonary specimens (8%). Escherichia coli (64%) was isolated most frequently, mainly in outpatients, whereas Klebsiella spp. and …