Early appropriate diagnostics and treatment of MDR Gram-negative infections
Issued Date
2022-10-01
Resource Type
eISSN
26321823
Scopus ID
2-s2.0-85144642151
Journal Title
JAC-Antimicrobial Resistance
Volume
4
Issue
5
Rights Holder(s)
SCOPUS
Bibliographic Citation
JAC-Antimicrobial Resistance Vol.4 No.5 (2022)
Suggested Citation
Bassetti M., Kanj S.S., Kiratisin P., Rodrigues C., Van Duin D., Villegas M.V., Yu Y. Early appropriate diagnostics and treatment of MDR Gram-negative infections. JAC-Antimicrobial Resistance Vol.4 No.5 (2022). doi:10.1093/jacamr/dlac089 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85459
Title
Early appropriate diagnostics and treatment of MDR Gram-negative infections
Author's Affiliation
Siriraj Hospital
Sir Run Run Shaw Hospital
IRCCS San Martino Polyclinic Hospital
Universidad El Bosque
American University of Beirut Medical Center
Università degli Studi di Genova
P.D. Hinduja National Hospital and Medical Research Centre
UNC School of Medicine
Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province
Sir Run Run Shaw Hospital
IRCCS San Martino Polyclinic Hospital
Universidad El Bosque
American University of Beirut Medical Center
Università degli Studi di Genova
P.D. Hinduja National Hospital and Medical Research Centre
UNC School of Medicine
Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province
Other Contributor(s)
Abstract
The term difficult-to-treat resistance has been recently coined to identify Gram-negative bacteria exhibiting resistance to all fluoroquinolones and all β-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.