A new review, recently published in the medical journal The Lancet Infectious Diseases, has cast a critical eye over the evidence surrounding recent rises in antibiotic resistance.

The paper has been co-authored by one of the Centre’s microbiology experts, Dr William Gaze, and considers the numerous factors that have contributed to the persistent rise of antibiotic resistance in the clinic including human use of antibiotics, their presence in the environment and billions of years of bacterial evolution.

The occurrence of bacteria resistant to conventional antibiotics was recently described by Chief Medical Officer Dame Sally Davies as a potential “apocalyptic scenario”. Describing a future where people undergoing simple operations may die of routine infections “because we have run out of antibiotics” Dame Davies said that “there are few public health issues of potentially greater importance for society than antibiotic resistance”.

There are a variety of mechanisms that result in bacteria acquiring resistance; some are simply mutations in existing genes that produce resistant traits, whilst others involve the transfer of genetic material between (sometimes distantly) related bacteria.

The disposal of waste water combined with farming practices (more antibiotics are used in farming than in human medicine) has led to antibiotic residues and other bio-active pharmaceuticals entering the environment. Once there, these chemicals can promote the development of antibiotic resistance and its emergence in bacteria that can influence humans and recent studies have shown that we can be exposed to these bacteria either through the food chain, or by direct contact with the environment – such as swimming in contaminated bathing waters.

The review draws attention to a number of ways in which the rise of resistance can be slowed, many of which centre on reducing the amount of microbial pollution in the environment through mechanisms such as improved waste water treatment and the increased use of biodegradable drugs.

The paper is published in The Lancet Infectious Diseases edition and is available online here