View source for Multidrug-resistant Gram-negative bacteria

{{Short description|Gram-negative bacteria with resistance to multiple antibiotics}}
'''Multidrug resistant Gram-negative bacteria''' ('''MDRGN bacteria''') are a type of [[Gram-negative]] bacteria with [[Multiple drug resistance|resistance to multiple antibiotics]].  They can cause bacteria infections that pose a serious and rapidly emerging threat for hospitalized patients and especially patients in [[intensive care unit]]s.<ref name=":0" /> Infections caused by MDR strains are correlated with increased morbidity, mortality, and prolonged hospitalization.  Thus, not only do these bacteria pose a threat to [[global public health]], but also create a significant burden to healthcare systems.<ref name=":0">{{Cite journal|last1=Cerceo|first1=Elizabeth|last2=Deitelzweig|first2=Steven B.|last3=Sherman|first3=Bradley M.|last4=Amin|first4=Alpesh N.|date=2016-07-01|title=Multidrug-Resistant Gram-Negative Bacterial Infections in the Hospital Setting: Overview, Implications for Clinical Practice, and Emerging Treatment Options|journal=Microbial Drug Resistance (Larchmont, N.Y.)|volume=22|issue=5|pages=412–431|doi=10.1089/mdr.2015.0220|issn=1931-8448|pmid=26866778}}</ref>
==Emerging threat==
These bacteria pose a great threat to public health due to the limited treatment options available as well as lack of newly developed antimicrobial medications. MDR strains of ''[[Enterobacteriaceae]]'', ''[[Pseudomonas aeruginosa]]'', and ''[[Acinetobacter baumannii]]'' have become of most concern because they have been reported by hospitals all around the United States.  There are many factors which could be contributed to the existence and spread of MDR gram-negative bacteria such as the: overuse or misuse of existing antimicrobial agents, which has led to the development of adaptive resistance mechanisms by bacteria; a lack of responsible antimicrobial stewardship such that the use of multiple broad-spectrum agents has helped perpetuate the cycle of increasing resistance; and a lack of good infection control practices.<ref name=":0" />
==Treatment options==
Although there is currently a shortage of new drugs in the antimicrobial realm, there are a few antibiotics currently being studied and tested for the treatment of serious Gram-negative bacterial infections. These include cephalosporins, ceftobiprole, ceftarolin and FR-264205.<ref name=":1">{{Cite journal|last1=Vergidis|first1=Paschalis I.|last2=Falagas|first2=Matthew E.|date=2008-02-01|title=Multidrug-resistant Gram-negative bacterial infections: the emerging threat and potential novel treatment options|journal=Current Opinion in Investigational Drugs|volume=9|issue=2|pages=176–183|issn=1472-4472|pmid=18246520}}</ref> The lack of newly emerging antimicobrial drugs have resulted in the revisit of old antibiotic drugs such as colistin (Polymyxins) and fosfomycin, which are traditionally considered to be toxic but have gained a principal role in the treatment of the most problematic MDR Gram-negative pathogens including ''Pseudomonas aeruginosa'', ''Acinetobacter baumannii'', ''Klebsiella pneumoniae'' and ''Stenotrophomonas maltophilia''. Also, there has been interest in the drug Tigecycline, which is from the class of antibiotics called glycylcyclines, for treating MDRGN infections.<ref name=":1" /> This drug shows promise in infections from multi-drug resistant ''K. pneumoniae'' (K. pneumoniae carbapenemase [KPC]- and ESBL-producing strains) and ''Enterobacteriaceae'' with various mechanisms of resistance.<ref>{{Cite journal|last1=Giamarellou|first1=Helen|last2=Poulakou|first2=Garyphallia|date=2009-10-01|title=Multidrug-resistant Gram-negative infections: what are the treatment options?|journal=Drugs|volume=69|issue=14|pages=1879–1901|doi=10.2165/11315690-000000000-00000|issn=1179-1950|pmid=19747006|s2cid=5967112 |doi-access=free}}</ref> A review of investigational antibiotics shows that several new agents will become available in the coming years, even though the pace of antimicrobial research has proven far too slow.
{{cquote|Overuse of antimicrobial agents and problems with infection control practices have led to the development of multidrug-resistant gram-negative bacterial infections. We used to use [[carbapenems]] as the main option in several countries for those severe infections; however, now there are several mechanisms of resistance, including carbapenemase production among ''[[Acinetobacter]]'', ''[[Pseudomonas]]'', and ''[[Klebsiella]]''  isolates. Subsequently, carbapenems are sometimes not active against those serious infections. That is why clinicians around the world have reconsidered the use of older antimicrobial agents, including [[polymyxins]]. — Matthew Falagas, MD.}}
The above quote was taken from an interview by Luke F. Chen, at the [[Infectious Diseases Society of America]] 2010 Annual Meeting.<ref>{{Cite news
| last = Chen | first = Luke F.
| title = The Increasing Threat of Multidrug-Resistant Gram-Negative Infections
| newspaper = Medscape Medical News
| publisher = WebMD
| date = 23 Nov 2010
| url = http://www.medscape.com/viewarticle/732946
| access-date = 1 December 2010}}</ref>  A study of MDRGN in long-term care facilities, reported in 2010, concluded that patients with severe dementia who require assistance with the activities of daily life are at high risk of MDRGN co-colonization and may be the "[[super-spreader]]s" of MDRGN in these facilities.<ref>{{Cite conference
| first = Snyder
| last = Graham M. |author2=O'Fallon, E |author3=D'Agata, EMC
| title = Risk Factors for Co-Colonization with Multidrug-Resistant Gram-Negative Bacteria in a Long-Term Care Facility
| publisher = International Conference on Healthcare-Associated Infections
| date = 21 Mar 2010
| location = Atlanta
| url = http://shea.confex.com/shea/2010/webprogram/Paper1601.html
| access-date = 1 December 2010}}</ref>
==See also==
* [[Antibiotic resistance]]
* [[Drug resistance]]
* [[Multiple drug resistance]]
==References==
{{Reflist}}
{{Pharmacology}}
{{Use dmy dates|date=November 2020}}
[[Category:Antibiotic-resistant bacteria]]