title: Patient specific risk stratification for antimicrobial resistance and possible treatment strategies in gram-negative bacterial infections.
abstract: The isolation of multi-drug-resistant gram-negative (MDRGN) pathogens has progressively increased worldwide and has been associated with important delays in the prescription of an adequate antibiotic treatment, resulting in increased mortality rates. Patient's stratification for MDRGN infections to optimize the prescription of an adequate empiric antimicrobial regimen is crucial. Areas covered: This article covers MDRGN epidemiology, with a specific focus on risk factors for harbouring infections sustained by extended-spectrum-Beta-lactamase (ESBL), carbapenem resistant Enterobacteriacae (CRE), MDR Pseudomonas aeruginosa and MDR Acinetobacter baumanii. Moreover, we will propose an algorithm for the choice of empiric treatment when a MDRGN infection is suspected. Expert commentary: Although in clinical practice, a patient's stratification represents a challenge, whenever a MDRGN pathogen is suspected broad-spectrum, combination empiric treatment should be promptly started, looking for a balance between the prescription of an adequate empiric treatment and the risk of resistance selection.
authors: a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy.
authors: Matteo
authors: M
authors: Bassetti
authors: a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy.
authors: Alessia
authors: A
authors: Carnelutti
authors: a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy.
authors: Maddalena
authors: M
authors: Peghin
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000201:enzymology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000201:enzymology; D018570:Risk Assessment; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: A.baumanii; CRE; ESBL; Gram-negative pathogens; Multi-drug-resistant; P.aeruginosa; carbapenemase