Korean J Med.  2015 May;88(5):502-508. 10.3904/kjm.2015.88.5.502.

Antimicrobial Therapy for Infections Caused by Multidrug-Resistant Gram-Negative Bacteria

• Kang CI

• KMID: 1834036
• DOI: http://doi.org/10.3904/kjm.2015.88.5.502

Abstract

The incidence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has increased over the past decade and extensively drug-resistant (XDR) infections are now on the rise, especially in non-fermenters such as Pseudomonas and Acinetobacter species. Unfortunately, our therapeutic options for these pathogens are extremely limited. Infections due to antimicrobial-resistant bacteria are associated with a greater likelihood of inappropriate antimicrobial therapy, which has adverse effects on the outcomes of patients with serious infections. Physicians who are treating immunocompromised patients should be aware of not only the current epidemiological status of antimicrobial resistance but also appropriate antimicrobial therapy for MDR pathogens. Although carbapenems are considered a mainstay for the treatment of extended-spectrum beta-lactamase (ESBL) or AmpC beta-lactamase-producing pathogens, antimicrobial stewardship for the appropriate use of carbapenems should be implemented to preserve these important antimicrobial agents. For carbapenem-resistant XDR infections, colistin and tigecycline could be considered a therapeutic option, based on the in vitro antibacterial spectrum, although the optimum treatment has not been established. This review provides a recent update of the antimicrobial therapeutic strategies for serious infections due to MDR or XDR Gram-negative bacteria, such as ESBL-producers and carbapenem-resistant pathogens.

Keyword

Gram-negative bacteria; Antimicrobial resistance; Multidrug resistance; Antimicrobial therapy; Treatment outcome

MeSH Terms

Acinetobacter
Anti-Infective Agents
Bacteria
beta-Lactamases
Carbapenems
Colistin
Drug Resistance, Multiple
Gram-Negative Bacteria*
Humans
Immunocompromised Host
Incidence
Pseudomonas
Treatment Outcome
Anti-Infective Agents
Carbapenems
Colistin
beta-Lactamases