Current status of gram-negative bacilli infections and strategies of treatment / 解放军医学杂志

ABSTRACT

With rapid ageing population,the extensive application of mechanical ventilation and development of organ transplantation,infection caused by gram-negative (G-) bacilli,which have become the common pathogens causing nosocomial (especially ICU) infection,has increased and accounted for more than 65% of the hospital acquired infections.Severe infections in intensive care units are usually caused by Pseudomonas aeruginosa,Acinetobacter sp.,Enterobacteriaceae bacteria and Stenotrophomonas maltophilia,presenting challenges to the treatment.In addition,drug-resistant G-bacilli strains have increased year by year,accompanying with appearance of muti-drug resistant and pan-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii.Several pathways may lead to drug resistance of G-bacilli,including permeability changes in ectal membrane,reformation of penicillin-binding protein,enhancement in level of pump MexAB-OprM,overproduction of antibiotic modification enzymes such as cephalosporinase,new type of beta-lactamases especially extended-spectrum beta-lactamases (ESBLs),AmpC beta-lactamase and Klebsiella pneumoniae carbapenemase (KPC).Clinical work is facing the challenges caused by drug resistance of G-bacilli,so the isolation and cultivation of pathogenic bacteria,drug sensitivity test in vitro,monitoring of drug resistance and researches on resistant mechanism should be enhanced,and proper antibiotics should be selected for treatment of G-bacilli infection.Polymyxin is recommended,if necessary,for treatment of multi-and pan-resistance G-bacilli infection,meanwhile the adverse effects of polymyxin treatment should be closely monitored.