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Development of resistance during antimicrobial therapy: a review of antibiotic classes and patient characteristics in
D N Fish1, S C Piscitelli, L H Danziger
1University of Colorado Health Sciences Center, Department of Pharmacy Practice, School of Pharmacy, Denver 80262, USA.
Abstract:
The incidence of emergent resistance and clinical factors affecting its development were evaluated by retrospective review of 173 studies encompassing over 14,000 patients. Eight antibiotic classes and 225 individual treatment regimens were evaluated. Emergent resistance occurred among 4.0% of all organisms and 5.6% of all infections treated. It appeared to be significantly more frequent with penicillin and aminoglycoside monotherapy, with significantly lower rates associated with imipenem-cilastatin, aztreonam, and combination therapy. Clinical failure also appeared to be significantly more likely to occur after emergence of resistance among organisms treated with fluoroquinolones or aminoglycosides. Infections associated with higher resistance rates were cystic fibrosis, osteomyelitis, and lower respiratory tract infections. Resistance was most common in patients in intensive care units or receiving mechanical ventilation. It was also significantly frequent among studies performed in university or teaching hospitals. Organisms associated with high resistance rates were Pseudomonas aeruginosa, Serratia, Enterobacter, and Acinetobacter sp. Factors such as infection type, underlying diseases, type of institution, and specific pathogens warrant consideration when examining emergent resistance.
Insights
Emergent antibiotic resistance developed in 4.0% of organisms and 5.6% of infections, with higher rates for certain antibiotics and patient groups. Factors like infection type and pathogens influence resistance development.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antimicrobial resistance is a growing global health concern.
- Understanding factors influencing emergent resistance is crucial for effective treatment strategies.
Purpose of the Study:
- To evaluate the incidence of emergent resistance.
- To identify clinical factors associated with the development of emergent resistance.
Main Methods:
- Retrospective review of 173 studies.
- Analysis of over 14,000 patient cases.
- Evaluation of eight antibiotic classes and 225 treatment regimens.
Main Results:
- Emergent resistance occurred in 4.0% of organisms and 5.6% of infections.
- Higher resistance rates were observed with penicillin and aminoglycoside monotherapy.
- Lower resistance rates were associated with imipenem-cilastatin, aztreonam, and combination therapy.
- Clinical failure was more likely with fluoroquinolone or aminoglycoside resistance.
- High resistance rates were linked to cystic fibrosis, osteomyelitis, lower respiratory tract infections, ICU patients, mechanical ventilation, teaching hospitals, and specific pathogens (Pseudomonas aeruginosa, Serratia, Enterobacter, Acinetobacter).
Conclusions:
- Antibiotic resistance development varies significantly based on antibiotic class, treatment strategy, infection type, patient population, and pathogen.
- Imipenem-cilastatin, aztreonam, and combination therapies appear to be more effective in preventing emergent resistance.
- Specific clinical settings and patient factors necessitate careful consideration in managing and preventing antimicrobial resistance.