Medicus, Vol. 25 No. 1 Pneumonije, 2016.
Review article
Treatment of Sepsis and Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria
Marija Santini
Viktor Kotarski
Abstract
Infections caused by multidrug-resistant Gram-negative bacteria are one of the leading problems in modern medicine. Increasing rates of resistance to all available antibiotics leave physicians with very limited treatment options. Recent rise in carbapenems resistance is particularly worrying. The bacteria with the widest array of resistance mechanisms posing biggest problems are K. pneumoniae, A. baumannii and P. aeruginosa. The optimal treatment modalities for severe infections caused by these bacteria have not yet been determined, and today the combination of two or more antibiotics is frequently used. Most combinations are based on colistine and recommendations for treatment mostly rely on in vitro studies and small-scale observational studies. Newer antibiotics that will soon be available, such as plasmocin, eravacycline, ceftolozane/tazobactam, avibactam and relebactam, will provide some improvement and new treatment options, but there are still no antibiotics with new mechanisms of action that would bypass all known resistance mechanisms and provide an efficient empirical therapy for severe infections caused by multidrug-resistant Gram-negative bacteria. In addition to the development of new antibiotics, rational use of the available ones and improved infection control remain essential to decreasing the burden of disease caused by multidrug-resistant Gram-negative bacteria.
Keywords
multidrug-resistant Gram-negative bacteria; beta-lactamase; ESBL; carbapenemases; Pseudomonas; Acinetobacter; Klebsiella; combination therapy; colistin; fosfomycin; tigecycline; eravacycline; avibaktam; plazmocin
Hrčak ID:
161769
URI
Publication date:
13.7.2016.
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