Defining the need for new antimicrobials: clinical and economic implications of resistance in the hospitalised patient.
Resistance among pathogens causing the most common infections encountered in hospitalised patients is increasing. Due to this resistance, the clinical efficacy of current antimicrobial agents is decreasing against many pathogens, including Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa, extended-spectrum beta-lactamases, and AmpC beta-lactamase-producing organisms. Studies assessing the impact of these resistance mechanisms on clinical outcomes have been performed; however, studies determining the economic impact of resistance have been limited. Strategies to retain the clinical efficacy of currently available agents include the initiation of antimicrobials with efficacy against the suspected pathogen(s) based on data obtained from local antibiograms, the use of combination therapy, and pharmacodynamic optimisation. Once a broad-spectrum regimen has been initiated, de-escalation to narrow, targeted antimicrobial therapy based on susceptibility data is warranted. Despite these efforts, new antimicrobials with novel mechanisms of action are eagerly anticipated to extend the current armamentarium against the growing population of multi-drug-resistant pathogens.
DeRyke
C Andrew
CA
Center for Anti-infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
Maglio
Dana
D
Nicolau
David P
DP
D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000639:trends; D003428:Cross Infection / Q000188:drug therapy* / Q000235:genetics / Q000382:microbiology; D004352:Drug Resistance, Microbial / Q000235:genetics / Q000502:physiology*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000235:genetics / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000235:genetics / Q000382:microbiology; D006760:Hospitalization; D006801:Humans
D000890:Anti-Infective Agents