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Mechanisms of bacterial antibiotic resistance
1Department of Pathology, Carolinas Medical Center, Charlotte, NC 28232-2861, USA.
Abstract:
Infectious complications are major contributing factors to morbidity and mortality in the ICU setting. Organisms frequently encountered in the ICU include Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae (particularly in trauma victims), enterococci, Klebsiella pneumoniae, Enterobacter spp., Acinetobacter baumanii, Escherichia coli, and Stenotrophomonas (Xanthomonas) maltophilia. Antibiotics have played a major role in the treatment of infections caused by such bacterial pathogens. Organisms have responded to the antibiotic challenge, however, evolving and developing resistance to all available antimicrobial agents to a greater or lesser degree. Specific mechanisms of resistance include reductions in cell-wall membrane permeability, alterations of antimicrobial agent target sites, enzymatic inactivation of antibiotics, and development of bypass pathways around antimicrobial targets. This article describes, pathogen by pathogen, antimicrobial agents that are useful for the treatment of infection in the ICU setting and the mechanisms whereby bacteria have short-circuited our antimicrobial armamentarium.
Insights
Intensive care unit (ICU) bacterial infections pose significant risks. This review details effective antibiotics for treating common ICU pathogens and explores bacterial resistance mechanisms, crucial for combating antimicrobial resistance.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Infectious complications are leading causes of morbidity and mortality in intensive care units (ICUs).
- Common ICU pathogens include Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, enterococci, Klebs pneumoniae, Enterobacter spp., Acinetobacter baumannii, E. coli, and S. maltophilia.
- Antibiotics are vital for treating these bacterial infections, but widespread resistance is a growing concern.
Purpose of the Study:
- To review antimicrobial agents effective against common ICU bacterial pathogens.
- To describe the mechanisms of antimicrobial resistance employed by these bacteria.
- To provide a pathogen-specific guide for selecting appropriate antibiotic therapies in the ICU.
Main Methods:
- Literature review and synthesis of existing data on ICU pathogens and antibiotic treatments.
- Detailed description of bacterial resistance mechanisms, including reduced permeability, target modification, enzymatic inactivation, and bypass pathways.
- Pathogen-by-pathogen analysis of recommended antimicrobial agents and their efficacy.
Main Results:
- Identifies key bacterial pathogens frequently causing ICU infections.
- Elucidates diverse mechanisms by which bacteria develop resistance to antibiotics.
- Outlines specific antibiotic strategies for treating infections caused by each major ICU pathogen.
Conclusions:
- Effective management of ICU infections requires understanding both causative pathogens and their evolving resistance mechanisms.
- Knowledge of antimicrobial agents and bacterial resistance is critical for optimizing patient outcomes and combating antimicrobial resistance.
- This review serves as a resource for clinicians managing complex infections in the ICU setting.