Antimicrobial resistance is a good example of interactive evolution between man's therapeutic, infection control, and health care delivery practices and the microbes. Are we facing a nightmare or nirvana? Our nightmare is perhaps that there may soon be no effective treatment for infections caused by antimicrobial resistant organisms, and that these would occur at such frequencies that we would in essence have returned to the preantimicrobial era.^1,2 We have in some parts of the world almost run out of antimicrobials for certain bacterial infections³ (I shall ignore in this article the challenges of viral, fungal, and protozoal infections), and physicians are having to face another nightmare scenario: harming patients with toxic antimicrobials that would not otherwise be marketed, or performing surgery without effective antimicrobial cover to prevent them dying from infection.

The title suggests that nirvana might be considered the opposite—a heavenly state where organisms are again susceptible. However, it is actually defined as “a state of blessedness when the soul is united with divine infinity and all personality is extinguished.” This definition could also imply a certain complacency and I shall return to this possibility shortly.

There was a great temptation when invited to write this article to let my imagination run wild. What will the future bring? Predictions are of obvious interest to patients, healthcare workers, politicians, and those investing in the stock market. Will we have optimised our genetic and environmental stress factors,⁴ or robotised ourselves using nanotechnology⁵ for maximum longevity? Will we have increased our resistance to infection with new vaccine strategies^6,7 or other approaches?⁸ Will we be using (reusable) gene chip technology,⁹ bacterial sniffing,¹⁰ or other technology¹¹ for immediate “Starship Enterprise” remote disease diagnosis? Might nanostructured artificial inorganic/organic biomaterials¹² or cloned tissue replacement …