title: Epidemiology of infections caused by multiresistant gram-negatives: ESBLs, MBLs, panresistant strains.
abstract: Microbial drug resistance is a growing problem of global magnitude. In gram-negative pathogens, the most important resistance problems are encountered in Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter, with increasing trends observed for all major anti-gram-negative agents (beta-lactams, fluoroquinolones and aminoglycosides). A matter of major concern is the emergence of new beta-lactamases capable of degrading the expanded-spectrum cephalosporins and/or carbapenems, such as the extended-spectrum beta-lactamases (ESBLs) and the carbapenemases. These beta-lactamase genes are often associated with resistance determinants to non-beta-lactam agents (e.g. aminoglycosides and fluoroquinolones), and strains producing ESBLs or carbapenemases often exhibit complex multidrug resistant phenotypes and sometimes are panresistant. The problem is worsened by the dearth of new agents active on multidrug-resistant Gram-negatives in the pipeline. The importance to develop better strategies to control resistance is underscored.
authors.affiliation: Department of Molecular Biology, Section of Microbiology, University of Siena, Italy. rossolini@unisi.it
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Mantengoli
authors.forename: Jean-Denis
authors.initials: JD
authors.lastname: Docquier
authors.forename: Rosa Anna
authors.initials: RA
authors.lastname: Musmanno
authors.forename: Grazietta
authors.initials: G
authors.lastname: Coratza
mesh_terms: D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000378:metabolism / Q000494:pharmacology; D002511:Cephalosporins / Q000378:metabolism / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005060:Europe / Q000453:epidemiology; D024841:Fluoroquinolones / Q000494:pharmacology; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000201:enzymology; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009656:North America / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*