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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antimicrobial Multidrug Resistance: Clinical Implications for Infection Management in Critically Ill Patients

Gamze Kalın1, Emine Alp2, Arthur Chouaikhi3

  • 1Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri 38280, Türkiye.

Microorganisms
|October 28, 2023
PubMed

Insights

Antimicrobial resistance (AMR) complicates sepsis treatment, increasing mortality and costs. Strategies like improved diagnostics and optimized dosing are crucial to combat multidrug-resistant (MDR) pathogens and curb resistance.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Rising antimicrobial resistance (AMR) poses a significant global health threat, particularly in managing sepsis.
  • Multidrug-resistant (MDR) pathogens complicate treatment, leading to delayed therapy, increased mortality, prolonged hospital stays, and higher healthcare costs.
  • Empirical broad-spectrum antibiotic use, driven by MDR concerns and slow diagnostics, exacerbates antibiotic overuse and promotes further resistance.

Purpose of the Study:

  • To review the epidemiology and trends of multidrug-resistant (MDR) pathogens.
  • To explore patient risk stratification for identifying susceptibility to MDR infections.
  • To discuss optimizing antimicrobial drug dosing as a key strategy against AMR.

Main Methods:

  • Literature review focusing on AMR, MDR pathogens, sepsis management, and antimicrobial stewardship.
  • Analysis of epidemiological data and trends in antimicrobial resistance.
  • Exploration of diagnostic and therapeutic strategies for optimizing antimicrobial use.

Main Results:

  • Increasing incidence of AMR globally, especially in intensive care units (ICUs), challenges empirical antibiotic therapy for sepsis.
  • Risk stratification and rapid molecular diagnostics can improve MDR pathogen identification, enabling tailored antimicrobial therapies.
  • Optimized dosing strategies, including continuous infusions, therapeutic drug monitoring (TDM), and combination therapy, are vital for effective treatment and resistance mitigation.

Conclusions:

  • Combating AMR requires a multi-faceted approach, including robust surveillance programs and advanced diagnostics.
  • Tailoring antimicrobial therapy based on patient risk and rapid diagnostics is essential to avoid unnecessary broad-spectrum antibiotic use.
  • Optimizing antimicrobial dosing and employing strategies like TDM and combination therapy can improve patient outcomes and limit the emergence of resistance.
Keywords:
ICUantimicrobial resistancedifficult to treat pathogenssepsis

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