Current challenges in antimicrobial chemotherapy: the impact of extended-spectrum β-lactamases and metallo-β-lactamases on the treatment of resistant Gram-negative pathogens

摘要: Gram-negative bacteria that produce extended-spectrum- and metallo-beta-lactamases are being discovered at an alarming rate, while the development of new antimicrobial agents has almost ground to a standstill. A body experience exists with detection treatment extended-spectrum beta-lactamase-producing organisms (Klebsiella pneumoniae Escherichia coli), suggesting knowledge their existence dissemination might have impact on therapeutic choices patient outcomes via targeted empirical selection infection control practices. It is unclear whether same mandate for metallo-beta-lactamases. As dictated by local susceptibility patterns, in many settings worldwide therapy serious nosocomial infections now requires use carbapenems alone or combination second antibiotic also effective against pathogens; colistin advocated as drug choice setting multidrug-resistant Pseudomonas aeruginosa infections, although high doses beta-lactams prove be effective.