The debate over the clinical significance of antimicrobial resistance among respiratory
tract pathogens has been ongoing for years, and clear answers currently are lacking
for many important questions. One important question is whether infections caused
by resistant organisms are more likely to be associated with adverse outcomes compared
with those caused by susceptible ones. Data suggest that adverse outcomes (eg, failure,
persistence) may be more likely for certain community-acquired respiratory tract infections
(eg, otitis media) caused by resistant pathogens [
1
,
2
,
3
,
4
]. For other infections (eg, pneumonia), the data are less clear [
5
,
6
,
7
,
8
,
9
,
10
,
11
,
12
]. Other important clinical questions focus on whether resistant strains are more or
less viable or virulent than susceptible strains. Some studies have suggested that
penicillin-resistant strains of Streptococcus pneumoniae are less viable than susceptible strains, a direct consequence of the very mechanism
by which resistance to penicillin is achieved [
13
,
14
,
15
,
16
]. For these strains, resistance may be associated with a significant biologic cost
to the organism (ie, decreased viability) [
[13]
]. Other studies have suggested that resistant organism are not more virulent than
susceptible strains and are not more likely to cause invasive disease. As a result,
many experts have postulated that resistant organisms may not be capable of competing
with susceptible strains for available resources, and they have “evolved” to a point
of self-extinction. However, bacteria have existed on this planet for nearly 3.5 billion
years, and an attribute of organisms that have survived this long is the ability to
adapt. Thus, there are those who believe that bacteria are capable of overcoming the
biologic cost of resistance, and resistant organisms will likely be an issue with
which to contend for years to come [
17
,
18
,
19
,
20
,
21
].To read this article in full you will need to make a payment
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