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KMID : 0614720220650080490
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Journal of Korean Medical Association
2022 Volume.65 No. 8 p.490 ~ p.497
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Antibiotics for multidrug-resistant gram-negative bacteria
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Kang Cheol-In
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Abstract
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Background: Increase in antimicrobial-resistant bacteria continues to be challenge to physicians. Particularly, multidrug-resistant (MDR) gram-negative bacilli (GNB), such as extended-spectrum beta-lactamase (ESBL)- producers and carbapenem-resistant pathogens, are becoming a major human health problem globally.
Current Concepts: Gram-negative bacteria have developed resistance via mechanisms encoding AmpC beta lactamases, ESBLs, and carbapenemases. The therapeutic options available for these pathogens are extremely limited. Infection by MDR bacteria is associated with ineffective antimicrobial therapy, which poses a major threat to the survival of patients with serious infections. Physicians should be familiar with the local epidemiology of MDR bacterial infections and the available therapeutic options. Carbapenems are considered as the drugs of choice for treating ESBL or AmpC-producers. However, increased use of carbapenems in response to an increased prevalence of MDR pathogens could be associated with the rapid emergence of carbapenem resistance. Therefore, there is an ongoing quest for carbapenem-sparing regimens for the treatment of MDR-GNB. Treatment of MDR-GNB infections need not be limited to carbapenems as novel antimicrobial agents are now available.
Discussion and Conclusion: This comprehensive review aims to describe therapeutic options available for MDR-GNB infections in Korea, a country with a high prevalence of MDR pathogens. Recently developed anti microbial agents that should be urgently introduced in Korea include ceftolozane-tazobactam, ceftazidime avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol. These drugs have been shown to be effective against carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.
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KEYWORD
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Anti-bacterial agents, Bacterial drug resistance, Gram-negative bacteria, Beta-lactamase inhibitors
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