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Multidrug-resistant gram-negative infections. Bringing back the old

Noreen H Chan-Tompkins1

  • 1Department of Pharmacy, Allegheny General Hospital, 320 E. North Ave., Pittsburgh, PA 15212, USA. ntompkin@wpahs.org

Critical Care Nursing Quarterly
|March 17, 2011
PubMed

Insights

Multidrug-resistant gram-negative infections pose treatment challenges due to limited options. New antimicrobial development is crucial to combat rising resistance in pathogens like Klebsiella pneumoniae.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Pharmacology

Background:

  • Multidrug-resistant (MDR) gram-negative infections present a significant global health challenge.
  • Increasing resistance in key pathogens like Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species limits treatment efficacy.
  • Carbapenems, once a primary treatment for ESBL-producing E. coli and Klebsiella, are becoming less effective due to carbapenemase-producing strains.

Purpose of the Study:

  • To highlight the challenges in treating MDR gram-negative infections.
  • To review current limited treatment options for MDR gram-negative pathogens.
  • To emphasize the need for novel antimicrobial development.

Main Methods:

  • Literature review of current antimicrobial armamentarium.
  • Analysis of resistance patterns in gram-negative pathogens.
  • Discussion of treatment limitations and emerging therapeutic strategies.

Main Results:

  • Limited commercially available anti-infectives are effective against MDR gram-negative infections.
  • Current options include tigecycline, polymyxin B, and colistin, each with potential toxicities (nephrotoxicity, neurotoxicity).
  • The rise of carbapenemase-producing K. pneumoniae necessitates alternative treatment approaches.

Conclusions:

  • Treatment of MDR gram-negative infections is increasingly difficult due to resistance.
  • Vigilance is required to manage adverse effects of polymyxins.
  • Support for initiatives like the Infectious Diseases Society of America's 10 × '20 Initiative is vital for future antimicrobial development.

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