Impact of antibiotic resistance in gram-negative bacilli on empirical and definitive antibiotic therapy

Paterson, David L. (2008) Impact of antibiotic resistance in gram-negative bacilli on empirical and definitive antibiotic therapy. Clinical Infectious Diseases, 47 Supp. 1: S14-S20. doi:10.1086/590062


Author Paterson, David L.
Title Impact of antibiotic resistance in gram-negative bacilli on empirical and definitive antibiotic therapy
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2008-09-15
Year available 2008
Sub-type Article (original research)
DOI 10.1086/590062
Open Access Status Not yet assessed
Volume 47
Issue Supp. 1
Start page S14
End page S20
Total pages 7
Editor Sherwood L. Gorbach
Place of publication Chicago Ill., U.S.A.
Publisher University of Chicago Press
Language eng
Subject C1
110309 Infectious Diseases
920109 Infectious Diseases
Abstract Serious infections with gram‐negative pathogens continue to be associated with considerable mortality. Increasing antibiotic resistance in organisms such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae is contributing to difficulties with choosing antibiotics to prescribe for these infections. Optimization of therapy against these organisms starts with the initial empirical antibiotic choice. Surveillance data and hospital or unit antibiograms may inform this decision, although individualization of the initial regimen on the basis of prior antibiotic use and prior isolation of resistant pathogens may be more important. Combinations of antibiotics are often required empirically, and “combination antibiograms” may need to be developed for this purpose. Preliminary data suggest that extending the time over which a dose of antipseudomonal β‐lactam antibiotics is infused may improve clinical outcomes; however, this idea remains to be confirmed in randomized trials. The role of direct susceptibility testing in aiding more‐rapid initiation of appropriate antibiotic therapy is also being studied. When identification and susceptibility testing is complete, the antibiotic regimen for infections due to gram‐negative pathogens can be “fine tuned.” On some occasions, this fine tuning necessitates the introduction of “salvage” antibiotics, such as colistin or tigecycline; on others, it necessitates de‐escalation and early termination of therapy. The lack of new antibiotic options against gram‐negative pathogens underscores the need for optimization of current therapies and prevention of the spread of these organisms.
Keyword Ventilator-associated Pneumonia
Complicated Intraabdominal Infections
Pseudomonas-aeruginosa Infection
Intensive-care-unit
Acinetobacter-baumannii
Antimicrobial Therapy
Hospitalized-patients
Fluoroquinolone Use
Controlled-trials
Tigecycline
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
UQ Centre for Clinical Research Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 43 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 29 Mar 2009, 21:31:13 EST by Carmen Buttery on behalf of UQ Centre for Clinical Research