Resistance to common antibiotics is becoming frequent in Australia and our response will require a multifaceted response, say experts in a clinical focus article published in the Medical Journal of Australia.

An emerging phenomenon is the rise of multidrug-resistant (MDR) gram-negative bacilli (GNB), particularly in commonly encountered bacteria belonging to the cach tri benh tieu duong hieu qua Enterobacteriaceae group (such as E. coli and Klebsiella). MDR GNB are microorganisms that may acquire genes that produce enzymes with the ability to negate the effects of antibiotics such as β-lactams (like penicillins, cephalosporins and carbapenems). Until recently we have relied up carbapenems (a broad- spectrum antimicrobial) for the treatment of many types of MDR GNB, but we are increasingly witnessing resistance to these 'last-line' drugs. Fatality rates attributed to serious infections caused by carbapenem-resistant Enterobacteriaceae are high (ranging from 19% to 48%).

MDR GNB exist at high rates in communities in the Asia-Pacific region. Travellers returning from these countries may carry resistant bacteria in their gastrointestinal tract and remain colonised for a considerable period of time. Should they develop an infection, they remain at significant risk of the bacteria being resistant to standard antbiotics.

Dr Patrick Harris, an infectious diseases physician and research scholar at the University of Queensland's Centre for Clinical Research, and coauthors wrote that the paucity of new antibiotic classes meant the nature of Australia's response to MDR GNBs was vital.

"[O]ur national response to these challenges will require a multifaceted approach, including widespread implementation of antimicrobial stewardship, enhanced surveillance, targeted screening of at-risk patients and improved infection control practices", the authors wrote.

"In the longer term, restriction of agricultural use of antibiotic classes critical to human medicine, removal of barriers to new drug development, and technological advances in rapid microbiological diagnostics will be required."

In Australia, rates of resistance in Escherichia coli to widely-used antibiotics (known as third- generation cephalosporins) have doubled in recent years, although remain low by international standards. Less than 2% were resistant in