J Korean Soc Transplant.  2013 Sep;27(3):81-86. 10.4285/jkstn.2013.27.3.81.

What's New in the Management of Bacterial Infections in the Era of Multidrug-Resistant Bacteria?

• Kang CI

• KMID: 1495863
• DOI: http://doi.org/10.4285/jkstn.2013.27.3.81

Abstract

Bacterial infection is an increasingly important diagnosis following successful organ transplantation in humans. This is notwithstanding the fact that opportunistic infections such as those of fungal and viral origin can occur frequently in this population. Infections due to multidrug resistant bacteria have been on the rise since the past decade and not surprisingly continue to challenge physicians. Recent studies show that rapidly increasing rates of infections in such population are due to methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacilli. Furthermore, pan-drug-resistant infections are now on the rise, especially in gram-negative bacilli. Regrettably, our therapeutic options for these pathogens are currently extremely limited. Very recently, it has been shown that infections due to Clostridium difficile spp. have been the leading cause of antibiotic-associated diarrhea. It is a well-known fact that infections due to antimicrobial-resistant bacteria were associated with a greater likelihood of inappropriate antimicrobial therapy. Therefore, it is very clear that inappropriate antimicrobial therapy has an adverse effect on survival rate in patients with serious infections. This is especially true in immunocompromised hosts. Hence, in the light of the above, it is very essential that physicians who are treating immunocompromised patients should be aware of not only current epidemiological status of antimicrobial resistance but also proper clinical practice guidelines to be followed while diagnosing infections due to such antimicrobial agents. The objective of this review is, therefore, to provide a recent update of currently available antimicrobial therapeutic strategies for life-threatening infections due to antimicrobial-resistant pathogens.

Keyword

Bacterial infections; Antimicrobial resistance; Antimicrobial agents

MeSH Terms

Anti-Infective Agents
Bacteria
Bacterial Infections
Clostridium difficile
Diarrhea
Humans
Immunocompromised Host
Light
Methicillin-Resistant Staphylococcus aureus
Opportunistic Infections
Organ Transplantation
Survival Rate
Transplants
Anti-Infective Agents

Reference

1). Kang CI, Song JH. Antimicrobial resistance in Asia: current epidemiology and clinical implications. Infect Chemother. 2013; 45:22–31.

2). Huh K, Kim J, Cho SY, Ha YE, Joo EJ, Kang CI, et al. Continuous increase of the antimicrobial resistance among gram-negative pathogens causing bacteremia: a nationwide surveillance study by the Korean Network for Study on Infectious Diseases (KONSID). Diagn Microbiol Infect Dis. 2013; 76:477–82.

3). Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the in-fectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011; 52:e18–55.

4). Park KH, Kim ES, Kim HS, Park SJ, Bang KM, Park HJ, et al. Comparison of the clinical features, bacterial genotypes and outcomes of patients with bacteraemia due to heteroresistant vancomycin-intermediate Staphylococ-cus aureus and vancomycin-susceptible S. aureus. J Antimicrob Chemother. 2012; 67:1843–9.

5). van Hal SJ, Lodise TP, Paterson DL. The clinical significance of vancomycin minimum inhibitory concen-tration in Staphylococcus aureus infections: a systematic review and meta-analysis. Clin Infect Dis. 2012; 54:755–71.

6). van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother. 2013; 57:734–44.

7). Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-re-sistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012; 54:621–9.

8). Walkey AJ, O'Donnell MR, Wiener RS. Linezolid vs gly-copeptide antibiotics for the treatment of suspected me-thicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials. Chest. 2011; 139:1148–55.

9). Wang JL, Hsueh PR. Therapeutic options for infections due to vancomycin-resistant enterococci. Expert Opin Pharmacother. 2009; 10:785–96.

10). Rodríguez-Baño J, Pascual A. Clinical significance of ex-tended-spectrum beta-lactamases. Expert Rev Anti Infect Ther. 2008; 6:671–83.

11). Kang CI. Therapeutic strategy for the management of multidrug-resistant gram-negative bacterial infections. J Korean Med Assoc. 2011; 54:325–31. (강철인. 다제내성 그람음성균 감염의 치료 전략. 대한의사협회지 2011;54:325-31.).

12). Kang CI, Cha MK, Kim SH, Ko KS, Wi YM, Chung DR, et al. Clinical and molecular epidemiology of com-munity-onset bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli over a 6-year period. J Korean Med Sci. 2013; 28:998–1004.

13). Rodríguez-Baño J, Navarro MD, Retamar P, Picón E. Pascual Á; Extended-Spectrum Beta-Lactamases-Red Española de Investigación en Patología Infecciosa/Grupo de Estudio de Infección Hospitalaria Group. β -Lactam/β -lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β -lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts. Clin Infect Dis. 2012; 54:167–74.

14). Kang CI, Park SY, Chung DR, Peck KR, Song JH. Piperacillin-tazobactam as an initial empirical therapy of bacteremia caused by extended-spectrum beta-lactamase- producing Escherichia coli and Klebsiella pneumoniae. J Infect. 2012; 64:533–4.

15). Tasina E, Haidich AB, Kokkali S, Arvanitidou M. Efficacy and safety of tigecycline for the treatment of in-fectious diseases: a meta-analysis. Lancet Infect Dis. 2011; 11:834–44.

16). Peña C, Suarez C, Ocampo-Sosa A, Murillas J, Almirante B, Pomar V, et al. Effect of adequate single-drug vs combination antimicrobial therapy on mortality in Pseudomonas aeruginosa bloodstream infections: a post Hoc analysis of a prospective cohort. Clin Infect Dis. 2013; 57:208–16.

17). Kelly CP, LaMont JT. Clostridium difficile–more diffi-cult than ever. N Engl J Med. 2008; 359:1932–40.

18). Kim YS, Han DS, Kim YH, Kim WH, Kim JS, Kim HS, et al. Incidence and clinical features of Clostridium difficile infection in Korea: a nationwide study. Epidemiol Infect. 2013; 141:189–94.

19). van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013; 368:407–15.

20). Gweon TG, Choi MG, Lee SK, Ha JH, Kim EY, Go BS, et al. Two cases of refractory pseudomembranous colitis that healed following fecal microbiota transplanation. Korean J Med. 2013; 84:395–9.S.