Abstract
The multidrug-resistant Gram-negative bacteria (MDR-GNB) infections in severely infected patients present numerous difficulties in terms of treatment failure where antibiotics cannot arrest such drug resistant bacteria. Based on the patient’s medical history and updated microbiological epidemiology data, an effective empirical treatment remains critical for optimal results to safeguard human health. The aim of this manuscript is to review management of MDR-Gram negative pathogenic bacterial infections. Quick diagnosis and narrow antimicrobial spectrum require rapid and timely diagnosis and effective laboratories in accordance with antimicrobial stewardship (AS) principles. Worldwide, there is an increased emergence of Carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas aeruginosa, and Acinetobacter baumannii. Recently, novel therapeutic options, such as meropenem/vaborbactam, ceftazidime/avibactam, ceftolozane/tazobactam, eravacycline and plazomicin became accessible to effectively counteract severe infections. Optimally using these delays the emergence of resistance to novel therapeutic agents. Further study is required, however, due to uncertainties in pharmacokinetic/pharmacodynamics optimization of dosages and therapeutic duration in severely ill patients. The novel agents should be verified for (i) action on carbapenem resistant Acinetobacter baumannii; (ii) action on CRE of β-lactam/β-lactamase inhibitors dependence on type of carbapenemase; (iii) emergence of resistance to novel antibacterials and dismiss selective pressure promoting development of resistance. Alternative treatments should be approached alike phage therapy or antibacterial peptides. The choice of empirical therapy is complicated by antibiotic resistance and can be combated by accurate antibiotic and their combinations usage, which is critical to patient survival. Noteworthy are local epidemiology, effective teamwork and antibiotic stewardship to guarantee that medications are utilized properly to counter the resistance.
Highlights
IntroductionRising incidences of Gram negative bacteria (GNB) have become an immense problem worldwide as it may decrease the therapeutic choices considerably and renders anti-bacterial drugs ineffective
Gram-negative pathogens and antimicrobial resistanceRising incidences of Gram negative bacteria (GNB) have become an immense problem worldwide as it may decrease the therapeutic choices considerably and renders anti-bacterial drugs ineffective
The novel agents should be verified for (i) action on carbapenem resistant Acinetobacter baumannii; (ii) action on Carbapenem-resistant Enterobacteriaceae (CRE) of β-lactam/β-lactamase inhibitors dependence on type of carbapenemase; (iii) emergence of resistance to novel antibacterials and dismiss selective pressure promoting development of resistance
Summary
Rising incidences of Gram negative bacteria (GNB) have become an immense problem worldwide as it may decrease the therapeutic choices considerably and renders anti-bacterial drugs ineffective. Fluoroquinolones are used in combination with at least one of the other agents, trimethoprim/ sulfamethoxazole, ceftazidime or tigecycline to treat infections caused by Stenotrophomonas maltophilia, as resistance is usual They can be used orally to handle UTI caused by susceptible MDR GNB10. This drug effectively combats ESBL-producing E. coli but not the carbapenemase producers Individuals infected with these strains can be treated with carbapenems and orally followed up on pivmecillinam alone for UTI due to mecillinam’s apparent activity in vitro 9. Advancements show that a newly noticed lysin, ABgp[46], withholds the capability to lyse many gram-negative and MDR pathogens such as Salmonella Typhimurium, A. baumannii, P. aeruginosa, and Streptococcus pneumoniae, among others This has led to the scientists discover that together, the phage lysins and antibiotics are more effective in abolishing infections in contrast to using antibiotics alone.
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