Antibiotic resistance in community-acquired pulmonary pathogens

Abstract Among infectious diseases, pneumonia is still the captain of the men of death. Etiologic diagnosis is often unreliable, consequently, clinicians must know epidemiology of community-acquired pneumonia for optimizing empiric antibiotic therapy. In recent years, all major pulmonary pathogens have become more and more resistant to conventional antibiotics. Penicillin- and even multi-resistant pneumococci have spread worldwide, but primarily in the United States, some European countries, South Africa, and the Far East. A similar trend is evidenced by ampicillin-resistant Haemophilus influenzae, whereas Moraxella catarrhalis almost invariably produces beta-lactamases. The widening of methicillin-resistant Staphylococcus aureus from hospitals to the community may be the new reality of the 1990’s. Increasing erythromycin resistance of Streptococcus pyogenes requires beta-lactam therapy. The spread of both cromosomally- and plasmid-mediated beta-lactamases makes treatment of infections caused by gram-negative enterobacilli more difficult. Bacterial resistance creates a challenge for clinicians from the viewpoint of correct and successful management of patients with community-acquired pneumonia.