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. 2023 Feb;36(1):65-81.
doi: 10.37201/req/119.2022. Epub 2022 Dec 13.

Antimicrobial resistance in Gram-negative bacilli in Spain: an experts' view

P Retamar-Gentil, R Cantón  1 , V Abril López de Medrano, J Barberán, A Canut Blasco, C Dueñas Gutiérrez, C García-Vidal, N Larrosa Escartín, J Lora-Tamayo, F J Martínez Marcos, C Martín Ruíz, J Pasquau Liaño, P Rascado, O Sanz Peláez, G Yagüe Girao, J P Horcajada
Affiliations

Antimicrobial resistance in Gram-negative bacilli in Spain: an experts' view

P Retamar-Gentil et al. Rev Esp Quimioter. 2023 Feb.

Abstract
in English, Spanish

Background: Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections.

Objective: The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence.

Methods: After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy.

Results and conclusions: Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.

Contexto: La resistencia a los antibióticos en bacilos gramnegativos representa un grave problema de salud pública. En el hospital, además de unas elevadas tasas de mortalidad, la aparición y propagación de resistencias a la práctica totalidad de los antibióticos limita las opciones terapéuticas frente a infecciones graves y frecuentes.

Objetivos: Este trabajo tiene por objetivo dar a conocer la visión de un grupo de expertos en los siguientes aspectos respecto a la resistencia a agentes antimicrobianos en bacilos gramnegativos: 1) la epidemiología actual en España, 2) su relación con la práctica clínica local y 3) las novedades terapéuticas en este ámbito, fundamentada en la evidencia actualmente disponible.

Metodología: Tras la revisión de la evidencia más destacada, los datos más relevantes de estos 3 aspectos fueron presentados en una reunión nacional ante 99 expertos en enfermedades infecciosas, microbiología clínica, medicina interna, medicina intensiva, anestesiología y farmacia hospitalaria.

Resultados y conclusiones: De debates locales posteriores entre estos expertos se extrajeron conclusiones al respecto entre las que se destacan que la aprobación de nuevos antibióticos hace necesaria la formación de los especialistas implicados para optimizar su uso y mejorar los resultados en salud; los laboratorios de Microbiología de los hospitales deben estar disponibles en horario continuado; todos los antibióticos deben estar disponibles para cuando sean necesarios y se debe aprender a usarlos de forma correcta; y los Programas de Optimización del Uso de Antimicrobianos (PROA) desempeñan una labor clave en ubicar de forma ágil los nuevos antibióticos en las guías y asegurar un uso apropiado de los mismos.

Keywords: Antimicrobial resistance; Enterobacterales; Multiresistance.

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Conflict of interest statement

Pilar Retamar-Gentil has taken part in training programmes organised by Menarini and MSD, and have participated in advisory board for Shionogi.

Rafael Cantón has taken part in training programmes organised by Menarini, MSD, Pfizer and Shionogi and in research studies funded by MSD, Shionogi and Venatorx.

Juan Pablo Horcajada has taken part in training programmes organised by Menarini, MSD and Pfizer.

Vicente Abril has received fees for educational activities and consulting work from Pfizer, Shionogi, Menarini, MSD and Angelini Pharma.

José Barberán has taken part in training programmes organised by MSD, Pfizer, Angelini and Shionogi.

Andrés Canut Blasco has taken part in training programmes organised by MSD and Pfizer.

Nieves Larrosa has taken part in training programmes organised by Menarini, MSD, Pfizer and Shionogi.

Jaime Lora-Tamayo has received fees for the following activities: aid to attend congresses: Pfizer, Novartis, Angelini Pharma, Advanz, Menarini; payment for conferences: Menarini, Novartis, Advanz; aid for research projects: Correvio; Advisory Boards: Pfizer, Debiopharm, Correvio, TenNor Therapeutics.

Carlos Martín has taken part in training programmes financed by MSD and Pfizer.

Juan Pasquau has taken part in training, consultancy and research activities financed by Pfizer, MSD, Angelini, Astellas, Advanz Pharma, Shionogi and Menarini.

Pedro Rascado has taken part in training programmes sponsored by Pfizer, MSD, Shionogi, Menarini.

Óscar Sanz has taken part in training programmes organised by Pfizer, MSD and Menarini, has participated as a speaker for Pfizer and as a consultant for Shionogi and has participated in research studies funded by Pfizer.

The following authors state they have no conflicts of interest: Carlos Dueñas Gutiérrez, Carolina García-Vidal; Genoveva Yagüe, and Francisco Javier Martínez Marcos.

Figures

Figure 1
Figure 1
Beta-lactamase classification. Adapted from Ambler et al [88]. Class A: serine-beta-lactamases; Class B: metallo-beta-lactamases; Class C: chromosomal or plasmid AmpC; and Class D: OXA-beta-lactamases. Main beta-lactamases regarding epidemiology are included.
See this image and copyright information in PMC

References

    1. ECDC Surveillance Atlas-Antimicrobial resistance. 2019. [cited 14 July 2022]. Available at: https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=4
    1. Antimicrobial Resistance Collaborators . Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed
    1. Cantón R, Huarte R, Morata L, Trillo-Mata JL, Muñoz R, González Jet al. . Determining the burden of infectious diseases caused by carbapenem-resistant gram-negative bacteria in Spain. Enferm Infecc Microbiol Clin (Engl Ed). 2021;39(4):179-83. doi: 10.1016/j.eimc.2020.04.009. - DOI - PubMed
    1. Ruiz-Garbajosa P, Cantón R. [Epidemiology of multi-drug resistant gramnegative bacilli]. Rev Esp Quimioter. 2016;29 Suppl 1:21-5. PMid: . - PubMed
    1. López-Cerero L, Egea P, Gracia-Ahufinger I, González-Padilla M, Rodríguez-López F, Rodríguez-Baño Jet al. . Characterisation of the first ongoing outbreak due to KPC-3-producing Klebsiella pneumoniae (ST512) in Spain. Int J Antimicrob Agents. 2014;44(6):538-40. doi: 10.1016/j.ijantimicag.2014.08.006. - DOI - PubMed

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