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Pharmacoepidemiology and evasion to anti-infectives (antibiotics, vaccine)

Over and above concerns relating to epidemic outbreaks in the community, as for A/H1N1, or in hospitals (healthcare-associated infections [HAIs]), new problems are arising due to the ability of many infectious agents to escape the effects of anti-infection agents by modifying their genotypes and, consequently, their phenotypes. Treatment resistance may have major health consequences. In some cases, the resistance is so strong that it leads to treatment failure. The epidemic of multidrug-resistant bacteria (MRB) has been rapidly growing over the last 20 years (e.g., methicillin-resistant Staphylococcus aureus [MRSA], extended spectrum β–lactamase [ESBL]-producing enterobacteria, Acinetobacter spp. resistant to imipenems, vancomycin-resistant enterococci, multidrug-resistant tuberculosis, Clostridium difficile, etc.). Vaccine evasion is a special case, because the evasion phenomenon is visible only at the population scale. Neither the clinician nor the microbiologist can accurately assess the extent of the problem. For example, serotype replacement following widespread vaccination with PCV–7 is now well documented. However, the extent to which these phenomena decrease vaccine efficacy remains unknown.

Our previous research activities have focused principally on a community pathogen, Streptococcus pneumoniae. We are now also working on other human pathogenic MRB, Staphylococcus aureus and enterobacteria, and on a virus, human papilloma virus (HPV).