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Review
. 2023 Oct 1;29(5):438-445.
doi: 10.1097/MCC.0000000000001074. Epub 2023 Jul 31.

Severe infections caused by difficult-to-treat Gram-negative bacteria

Silvia Dettori  1 , Federica Portunato  1 , Antonio Vena  1   2 , Daniele Roberto Giacobbe  1   2 , Matteo Bassetti  1   2
Affiliations
Review

Severe infections caused by difficult-to-treat Gram-negative bacteria

Silvia Dettori et al. Curr Opin Crit Care. .

Abstract

Purpose of review: Antimicrobial resistance (AMR) in Gram-negative bacteria (GNB) poses a significant global health concern, contributing to increased infections, mortality rates, and healthcare costs. This review discusses the main clinical manifestations, therapeutic options, and recent findings in managing antibiotic-resistant GNB, with a focus on difficult-to-treat infections.

Recent findings: Difficult-to-treat resistance (DTR) is a novel classification that identifies GNB exhibiting intermediate or resistant phenotypes to first-line agents in the carbapenem, beta-lactam, and fluoroquinolone categories. The main pathogens implicated in severe infections include DTR Enterobacterales, DTR Pseudomonas aeruginosa , and DTR Acinetobacter baumannii. Although the clinical implications of DTR strains are still under investigation, certain studies have linked them to prolonged hospital stays and poor patient outcomes.

Summary: Severe infections caused by DTR-GNB pose a formidable challenge for healthcare providers and represent a growing global health issue. The proper administration and optimization of novel antibiotics at our disposal are of paramount importance for combating bacterial resistance and improving patient prognosis.

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Conflict of interest statement

M.B. has participated in the past 5 years in advisory boards, research grants and/or received speaker bureau from Astellas, Pfizer, MSD, Gilead, Angelini, Bayer, Biomerieux, Cidara, Menarini, and Shionogi. The other authors declare no conflicts of interest.

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