title: Multidrug-resistant bacteria: what is the threat?
abstract: Despite big advances in antimicrobial therapies and infection strategies, the emergence of antibiotic resistance represents an emergency situation, especially in immunocompromised hosts. Specifically, infections due to multidrug resistant, gram-negative pathogens are responsible for high mortality rates and may leave few effective antimicrobial options. Furthermore, although new compounds are available for severe methicillin-resistant staphylococcal infections, there is a paucity of novel classes of antimicrobials to target resistant gram-negatives. A careful assessment of the clinical conditions and underlying comorbidities, along with knowledge about the previous history of colonization or infections due to multidrug-resistant bacteria, represent key points in approaching the hematological patient with signs of infection. A de-escalation therapy with initial use of wide-spectrum antimicrobials followed by a reassessment after 72 hours of treatment may represent a good option in severe infections if a resistant pathogen is suspected. Prompt empiric or targeted therapy using combination regimens (ie, antipseudomonal beta-lactam plus an aminoglycoside or a quinolone) with the addition of colistin, along with increased dosage and therapeutic drug monitoring, represent options for these life-threatening infections. Continuous epidemiological surveillance of local bacteremias is necessary, along with stringent enforcement of antibiotic stewardship programs in cancer patients.
authors: 1Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors: Matteo
authors: M
authors: Bassetti
authors: Elda
authors: E
authors: Righi
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D016867:Immunocompromised Host; D055624:Methicillin-Resistant Staphylococcus aureus; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents