Between and , acinetobacter species were the only .. forms provided by the authors are available with the full text of this article at Go to. Multidrug-resistant Acinetobacter baumannii (MDR-Ab) causes wound and bloodstream infections as well as ventilator-associated pneumonia. of human and animal origin in multiple countries (NEJM Journal Watch Acinetobacter spp., and Pseudomonas aeruginosa from inpatients.

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Overview of nosocomial infections caused by gram-negative bacilli. These organisms are highly efficient at up-regulating or acquiring genes that code for mechanisms of antibiotic drug resistance, especially in the presence of antibiotic selection pressure.

Hospital-Acquired Infections Due to Gram-Negative Bacteria

Infect Control Hosp Epidemiol. Comparison acinnetobacter 8 versus 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: The antibiotics selected for the combination, however, need to be tailored to local susceptibility data, because the benefits can be lost in the presence of high cross-resistance, such as to fluoroquinolones and third-generation cephalosporins.

Recent data from the U. Data on the clinical effect of initial therapy for gram-negative bloodstream infection are more heterogeneous.

Furthermore, they have available to them a plethora of resistance mechanisms, often using multiple mechanisms against the same antibiotic or using a single mechanism to affect multiple antibiotics Fig. Urinary Tract Infection Gram-negative organisms predominate in hospital-acquired urinary tract infections, almost all of which are associated with urethral catheterization.


In vitro activity of tigecycline against a range of troublesome gram-negative organisms, including ESBL-producing and carbapenemase-producing Enterobacteriaceae, acinetobacter species, and Stenotrophomonas maltophiliahas been reported P. One of the following regimens: The polymyxins colistin and polymyxin B are an older antibiotic class that has seen a resurgence of use in recent years and deserves mention. When definitive antibiotic therapy is warranted, a relatively short course 8 days should be prescribed for patients with uncomplicated ventilator-associated pneumonia who receive appropriate antibiotic therapy initially.

National Center for Biotechnology InformationU. N Engl J Med. Bloodstream infections including health care—associated infections. When the antibiotic susceptibilities of the infecting organism are known, monotherapy and combination therapy have similar outcomes, including rates of emergence of resistance and recurrence of infection.

Prevention of bloodstream infections associated with central catheters is of paramount importance.

Hospital-Acquired Infections Due to Gram-Negative Bacteria

Reassess the patient and recheck culture results at 48 to 72 hours, with the goal of tailoring antibiotic therapy to the susceptibilities of the cultured bacteria. Adherence to evidence-based interventions has proved highly successful Table 335 and hospitals worldwide should be adopting such cost-effective, preventive measures.

Colistin as for carbapenemase-producing Enterobacteriaceae For A. As with hospital-acquired pneumonia, delays in the administration of appropriate antibiotic therapy are associated with excess mortality among patients with hospital-acquired bloodstream infection, 32 although the data reflect predominantly gram-positive infections.

Open in a separate window. Treatment Options The importance of knowing local antimicrobial susceptibility to direct empirical antibiotic therapy cannot be overemphasized.

However, this class of antibiotic has been reinstated as a key therapeutic option for carbapenem-resistant organisms, particularly P.


The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. The urine concentrations of tigecycline are low, so it is not suitable for the treatment of urinary tract infections. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. Plus one of the following regimens: Treatment of health-care-associated infections caused by Gram-negative bacteria: To further improve such differentiation in patients with ventilator-associated pneumonia, promising biomarkers are being studied in combination with clinical and microbiologic factors.

Int J Antimicrob Agents. For example, of bloodstream isolates of Klebsiella pneumoniae from hospitals throughout the United States, Wyeth to file for FDA approval of Tygacil for the treatment of patients with community-acquired pneumonia. Gram-negative organisms predominate in hospital-acquired urinary tract infections, almost all of which are associated with urethral catheterization.

Red spheres indicate antibiotics. Estimating health care-associated infections and deaths in U.

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: No other conflict of interest relevant to this article was reported. Address reprint requests to Dr. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Risk factors for health care—associated infections.

These biomarkers include procalcitonin, C-reactive protein, and soluble triggering receptor expressed on myeloid cells sTREM