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Korean J Med > Volume 88(5); 2015 > Article
감염
The Korean Journal of Medicine 2015;88(5): 502-508.
다제내성 그람음성균 감염의 항생제 치료
강철인
성균관대학교 의과대학 삼성서울병원 감염내과
Antimicrobial Therapy for Infections Caused by Multidrug-Resistant Gram-Negative Bacteria
Cheol-In Kang
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: Cheol-In Kang ,Tel: +82-2-3410-0324, Fax: +82-2-3410-0064, Email: collacin@hotmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
The incidence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has increased over the past decade and extensively drug-resistant (XDR) infections are now on the rise, especially in non-fermenters such as Pseudomonas and Acinetobacter species. Unfortunately, our therapeutic options for these pathogens are extremely limited. Infections due to antimicrobial-resistant bacteria are associated with a greater likelihood of inappropriate antimicrobial therapy, which has adverse effects on the outcomes of patients with serious infections. Physicians who are treating immunocompromised patients should be aware of not only the current epidemiological status of antimicrobial resistance but also appropriate antimicrobial therapy for MDR pathogens. Although carbapenems are considered a mainstay for the treatment of extended-spectrum beta-lactamase (ESBL) or AmpC β-lactamase-producing pathogens, antimicrobial stewardship for the appropriate use of carbapenems should be implemented to preserve these important antimicrobial agents. For carbapenem-resistant XDR infections, colistin and tigecycline could be considered a therapeutic option, based on the in vitro antibacterial spectrum, although the optimum treatment has not been established. This review provides a recent update of the antimicrobial therapeutic strategies for serious infections due to MDR or XDR Gram-negative bacteria, such as ESBL-producers and carbapenem-resistant pathogens.
Keywords: Gram-negative bacteria; Antimicrobial resistance; Multidrug resistance; Antimicrobial therapy; Treatment outcome
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