Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections

Cheol-In Kang

doi:10.5124/jkma.2011.54.3.325

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Kang: Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2011; 54(3): 325-331.

Published online: 16 March 2011

DOI: https://doi.org/10.5124/jkma.2011.54.3.325

Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections

Cheol-In Kang, MD

Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Cheol-In Kang, collacin@hotmail.com

Received 8 February 2011 Accepted 22 February 2011

(open-access):

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Over the past decade, infections caused by antimicrobial-resistant bacteria have increased and continued to challenge physicians. Recent data show rapidly increasing rates of infection due to multidrug-resistant (MDR) gram-negative bacilli. Furthermore, pandrug-resistant infections now occur, especially due to gram-negative bacilli, and our therapeutic options for these pathogens are extremely limited. Infection caused by MDR bacteria was associated with a greater likelihood of inappropriate antimicrobial therapy, and inappropriate antimicrobial therapy has an adverse effect on survival in patients with serious infections. Consequently, it may be presumed that serious infections caused by MDR bacteria have a worse prognosis because of the delay in initiation of appropriate antimicrobial therapy. Empirical antibiotics for serious infections should be recommended on the basis of the distribution of pathogens and their susceptibility patterns in the institution where the regimen is administered. Therefore, physicians who are caring for patients with bacterial infection should be familiar with local antimicrobial susceptibility patterns and the epidemiology of MDR bacterial infections, in order to improve the treatment outcome of the patients. This comprehensive review aims to describe the epidemiology and clinical implications of MDR gram-negative bacterial infections in Korea, a country with a high prevalence of antimicrobial-resistant pathogens.

Keywords: Multidrug-resistant bacteria, Gram-negative bacterial infections, Epidemiology, Anti-infective agents

Figures and Tables

Table 1

Antimicrobial therapy for serious infections caused by multidrug-resistant-Klebsiella pneumoniae or Escherichia coli

ESBL, extended-spectrum β-lactamase.

Table 2

Antimicrobial therapy for serious infections caused by carbapenem-resistant-Pseudomonas aeruginosa or Acinetobacter baumannii

Carbapenem-resistant-P. aeruginosa or A. baumannii isolates might be susceptible to other classes of antibiotics (e.g., cefepime, piperacillin/tazobactam, and ciprofloxacin), particularly in isolates with porin mutation as the main mechanism of carbapenem resistance. In such cases, those antibiotics susceptible in vitro can be used.

Acknowledgement

This study was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2010-0021572).

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