title: The clinical impact of multidrug-resistant gram-negative bacilli in the management of septic shock.
abstract: Multi-antibiotic drug-resistant (MDR) gram-negative bacilli are becoming a major threat to the standard care of septic patients. Empiric antimicrobial drug regimens to cover likely bacterial pathogens have to be altered in keeping with the spread of MDR pathogens in the health care setting and in the community. Reliable antibiotics for broad spectrum coverage for sepsis such as extended spectrum β-lactam antibiotics, carbapenems, and fluoroquinolones can no longer be counted upon to provide activity against a range of common, virulent pathogens that cause sepsis. In some regions of Asia, South America, and Eastern Europe in particular, MDR pathogens have become a major concern, necessitating the use of potentially toxic and costly antibiotic combinations as initial antibiotic therapy for septic shock. In this brief review, we will focus on the emergence of MDR gram-negative pathogens, resistance mechanisms, and suggest some management and prevention strategies against MDR pathogens.
authors.affiliation: Infectious Disease Division; Memorial Hospital of RI; Providence, RI USA; The Alpert Medical School of Brown University; Providence, RI USA.
authors.forename: Aurora
authors.initials: A
authors.lastname: Pop-Vicas
authors.affiliation: Infectious Disease Division; Memorial Hospital of RI; Providence, RI USA; The Alpert Medical School of Brown University; Providence, RI USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Opal
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics / Q000502:physiology*; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents
keywords: bacterial resistance; extended antibiotic resistance; multidrug resistance; sepsis; septic shock