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Emerging antimicrobial resistance and the immunocompromised host
D M Shlaes1, B Binczewski, L B Rice
1Research Service, Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106.
Abstract:
Infections caused by gram-positive bacteria have become the most important cause of infectious morbidity among some groups of immunocompromised patients over the last decade. Among the gram-positive bacteria, the emerging problems of resistance to antimicrobial agents include the development of resistance to beta-lactam and aminoglycoside drugs among the enterococci, making synergistic bactericidal therapy impossible; the continued spread of methicillin-resistant staphylococci; resistance to both vancomycin and teicoplanin among enterococci and staphylococci; the emergence of intrinsically vancomycin-resistant species as important pathogens; and resistance to the fluoroquinolones. It is unlikely that new therapeutic classes of antibacterial drugs will be released this decade. Therapeutic alternatives now include unusual combinations of antibiotics to which the strains may appear resistant but that exhibit synergistic activity, although this area has not yet been thoroughly explored. Therefore, control of emergence and spread of resistance through the more judicious use of existing agents, good infection control practices, and the use of imaginative combination therapy for those infected with resistant strains seem to be our best alternatives.
Insights
Antimicrobial resistance in gram-positive bacteria is a growing threat, especially for immunocompromised patients. New treatments are limited, emphasizing careful antibiotic use and novel combination therapies to combat resistant infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Gram-positive bacterial infections are a major cause of illness in immunocompromised individuals.
- Antimicrobial resistance is escalating, particularly with enterococci and staphylococci.
Purpose of the Study:
- To highlight the critical issue of rising antimicrobial resistance in gram-positive pathogens.
- To discuss the challenges and potential strategies for managing infections caused by resistant bacteria.
Main Methods:
- Review of current trends in antimicrobial resistance among gram-positive bacteria.
- Analysis of emerging resistance mechanisms and their clinical implications.
Main Results:
- Key resistance issues include beta-lactam and aminoglycoside resistance in enterococci, methicillin-resistant staphylococci, vancomycin/teicoplanin resistance, and fluoroquinolone resistance.
- New classes of antibacterial drugs are unlikely to be available soon.
Conclusions:
- Judicious use of existing antibiotics and robust infection control are crucial.
- Exploring synergistic antibiotic combinations offers a promising therapeutic avenue for resistant infections.