Journal List > J Korean Soc Transplant > v.27(3) > 1034419

J Korean Soc Transplant. 2013 Sep;27(3):81-86. Korean.
Published online September 26, 2013.  https://doi.org/10.4285/jkstn.2013.27.3.81
Copyright © 2013 The Korean Society for Transplantation
What's New in the Management of Bacterial Infections in the Era of Multidrug-Resistant Bacteria?
Cheol-In Kang, M.D.
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (Email: collacin@hotmail.com )
Received August 22, 2013; Accepted August 29, 2013.

Abstract

Bacterial infection is an increasingly important diagnosis following successful organ transplantation in humans. This is notwithstanding the fact that opportunistic infections such as those of fungal and viral origin can occur frequently in this population. Infections due to multidrug resistant bacteria have been on the rise since the past decade and not surprisingly continue to challenge physicians. Recent studies show that rapidly increasing rates of infections in such population are due to methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacilli. Furthermore, pan-drug-resistant infections are now on the rise, especially in gram-negative bacilli. Regrettably, our therapeutic options for these pathogens are currently extremely limited. Very recently, it has been shown that infections due to Clostridium difficile spp. have been the leading cause of antibiotic-associated diarrhea. It is a well-known fact that infections due to antimicrobial-resistant bacteria were associated with a greater likelihood of inappropriate antimicrobial therapy. Therefore, it is very clear that inappropriate antimicrobial therapy has an adverse effect on survival rate in patients with serious infections. This is especially true in immunocompromised hosts. Hence, in the light of the above, it is very essential that physicians who are treating immunocompromised patients should be aware of not only current epidemiological status of antimicrobial resistance but also proper clinical practice guidelines to be followed while diagnosing infections due to such antimicrobial agents. The objective of this review is, therefore, to provide a recent update of currently available antimicrobial therapeutic strategies for life-threatening infections due to antimicrobial-resistant pathogens.

Keywords: Bacterial infections; Antimicrobial resistance; Antimicrobial agents

Tables


Table 1
Recommendations for the antimicrobial treatment of MRSA infections
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Table 2
Antimicrobial therapy for serious infections caused by MDR-Klebsiella pneumoniae or Escherichia coli
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Table 3
Antimicrobial therapy for serious infections caused by carbapenem-resistant-Pseudomonas aeruginosa or Acinetobacter baumanniia
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Table 4
Suggested approaches to therapy for Clostridium difficile infection
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References
1. Kang CI, Song JH. Antimicrobial resistance in Asia: current epidemiology and clinical implications. Infect Chemother 2013;45:22–31.
2. Huh K, Kim J, Cho SY, Ha YE, Joo EJ, Kang CI, et al. Continuous increase of the antimicrobial resistance among gram-negative pathogens causing bacteremia: a nationwide surveillance study by the Korean Network for Study on Infectious Diseases (KONSID). Diagn Microbiol Infect Dis 2013;76:477–482.
3. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18–e55.
4. Park KH, Kim ES, Kim HS, Park SJ, Bang KM, Park HJ, et al. Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococcus aureus and vancomycin-susceptible S. aureus. J Antimicrob Chemother 2012;67:1843–1849.
5. van Hal SJ, Lodise TP, Paterson DL. The clinical significance of vancomycin minimum inhibitory concentration in Staphylococcus aureus infections: a systematic review and meta-analysis. Clin Infect Dis 2012;54:755–771.
6. van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013;57:734–744.
7. Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis 2012;54:621–629.
8. Walkey AJ, O'Donnell MR, Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest 2011;139:1148–1155.
9. Wang JL, Hsueh PR. Therapeutic options for infections due to vancomycin-resistant enterococci. Expert Opin Pharmacother 2009;10:785–796.
10. Rodríguez-Baño J, Pascual A. Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther 2008;6:671–683.
11. Kang CI. Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections. J Korean Med Assoc 2011;54:325–331.
12. Kang CI, Cha MK, Kim SH, Ko KS, Wi YM, Chung DR, et al. Clinical and molecular epidemiology of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli over a 6-year period. J Korean Med Sci 2013;28:998–1004.
13. Rodríguez-Baño J, Navarro MD, Retamar P, Picón E, Pascual Á. Extended-Spectrum Beta-Lactamases-Red Española de Investigación en Patología Infecciosa/Grupo de Estudio de Infección Hospitalaria Group. β-Lactam/β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts. Clin Infect Dis 2012;54:167–174.
14. Kang CI, Park SY, Chung DR, Peck KR, Song JH. Piperacillin-tazobactam as an initial empirical therapy of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. J Infect 2012;64:533–534.
15. Tasina E, Haidich AB, Kokkali S, Arvanitidou M. Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis. Lancet Infect Dis 2011;11:834–844.
16. Peña C, Suarez C, Ocampo-Sosa A, Murillas J, Almirante B, Pomar V, et al. Effect of adequate single-drug vs combination antimicrobial therapy on mortality in Pseudomonas aeruginosa bloodstream infections: a post Hoc analysis of a prospective cohort. Clin Infect Dis 2013;57:208–216.
17. Kelly CP, LaMont JT. Clostridium difficile--more difficult than ever. N Engl J Med 2008;359:1932–1940.
18. Kim YS, Han DS, Kim YH, Kim WH, Kim JS, Kim HS, et al. Incidence and clinical features of Clostridium difficile infection in Korea: a nationwide study. Epidemiol Infect 2013;141:189–194.
19. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013;368:407–415.
20. Gweon TG, Choi MG, Lee SK, Ha JH, Kim EY, Go BS, et al. Two cases of refractory pseudomembranous colitis that healed following fecal microbiota transplanation. Korean J Med 2013;84:395–399.
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