Community-acquired antimicrobial resistance: is it controllable?

Antimicrobial agents were introduced into medical use about 50 years ago. Since then, the prevalence of antimicrobial resistance in community-acquired pathogens has increased rapidly worldwide. The relationship between antibiotic use and resistance is strongly supported by data from several studies. In Spain, the resistance rates for community-acquired pathogens are among the highest in Europe and coincide with a high consumption of antimicrobial agents. In contrast, in Finland, after a nationwide reduction in the use of macrolides for outpatient therapy, there has been a significant decline in the frequency of erythromycin resistance among group A streptococcal isolates. The control of community-acquired antimicrobial resistance is a challenge for the future and will require the early detection of resistance genes through global and local surveillance, prompt containment of resistant pathogens, and judicious use of antimicrobials.