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Clinical Concepts 1
Treatment of Infectious Diseases in Environments with Increasing Numbers of Multipledrug Resistant Bacteria
(Based on the Japanese original by Dr. Yoshikazu Ito,
First Department of Internal Medicine, Tokyo Medical University)
Today, many infectious diseases are being caused by multipledrug resistant bacteria such as
methicillinresistant Staphylococcus aureus (MRSA). The main factor behind the increased
number of multipledrug resistant bacteria is considered to be the frequent daily use of broad
spectrum antibiotics. There have therefore been growing efforts to administer antibiotics in a
careful and appropriate manner against infectious diseases.
Infectious diseases result from microbial invasion of the human body, which affects the host
tissues and their functions. Basically, the approach to the treatment of infectious diseases is the
identification of the organism causing a disorder and the selection of a suitable antibiotic
against it. However, the bacterium detected in microbiological examinations is not always the
actual cause of inflammation. We are surrounded by large numbers of microorganisms, and
many of them have established themselves within our bodies. The types of organisms and the
circumstances of their presence inside the body vary greatly with the host defense against
infection. In bacteriologic examinations, the characteristics of the specimens and detected
conditions of the bacteria should be taken into account. It is essential to identify the causative
agent before an antibiotic is administered. However, on occasion, treatment with antibiotics
may be initiated before the pathogen is identified, but it is necessary to fully understand the
properties of each antibiotic when a drug is selected for treatment.
It is important to remember that no antibiotic can render a person bacteriafree, however
effective it is. The longterm use of an antibiotic inevitably causes microbial substitution, in
which the resident flora are replaced with microorganisms on which the antibiotic has no effect.
The history of bacteria is much longer than that of humans, and during it, bacteria have gone
through various environmental changes. Humans can never gain full control over microbes and
there is no point in trying to do so. One reason, however, for the increased number of multiple
drugresistant bacteria is that many health professionals did not understand this viewpoint.
Infectious disease treatment with antibiotics tends to focus on elimination of the causative
agents. However, for immunocompromised people such as the elderly, cancer patients, and
patients whose biological barriers have been impaired for medical purposes, the increase in the
number of multipledrug resistant bacteria has become a problem of increasing seriousness. It is
vital to consider how infectious disease treatment should be conducted, starting with the
coexistence of humans and microbes as a basic concept.