Early appropriate diagnostics and treatment of MDR Gram-negative infections

Autores organización

• 

  Maria Virginia Villegas Botero

  Autor

Autores

• Bassetti M
• Kanj SS
• Kiratisin P
• Rodrigues C
• Van Duin D
• Yu Y

Grupos de investigación

• Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria RAEH

  

  Investigador

  Maria Virginia Villegas Botero

Resumen

The term difficult-to-treat resistance has been recently coined to identify Gram-negative bacteria exhibiting resistance to all fluoroquinolones and all ß-lactam categories, including carbapenems. Such bacteria are posing serious challenges to clinicians trying to identify the best therapeutic option for any given patient. Delayed appropriate therapy has been associated with worse outcomes including increase in length of stay, increase in total in-hospital costs and ~20% increase in the risk of in-hospital mortality. In addition, time to appropriate antibiotic therapy has been shown to be an independent predictor of 30 day mortality in patients with resistant organisms. Improving and anticipating aetiological diagnosis through optimizing not only the identification of phenotypic resistance to antibiotic classes/agents, but also the identification of specific resistance mechanisms, would have a major impact on reducing the frequency and duration of inappropriate early antibiotic therapy. In light of these considerations, the present paper reviews the increasing need for rapid diagnosis of bacterial infections and efficient laboratory workflows to confirm diagnoses and facilitate prompt de-escalation to targeted therapy, in line with antimicrobial stewardship principles. Rapid diagnostic tests currently available and future perspectives for their use are discussed. Early appropriate diagnostics and treatment of MDR Gram-negative infections require a multidisciplinary approach that includes multiple different diagnostic methods and further consensus of algorithms, protocols and guidelines to select the optimal antibiotic therapy. © 2022 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.

© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.

Keywords

• adult; algorithm; antibiotic resistance; antibiotic sensitivity; antibiotic therapy; antimicrobial stewardship; bacterial infection; consensus; developing country; diagnostic procedure; early diagnosis; empirical research; Gram negative infection; human; molecularly targeted therapy; mortality; phenotypic variation; practice guideline; Review; workflow