This article is part of the supplement: Optimizing the use of carbapenems in the face of increasing Gram-negative resistance

Review

Gram-negative antibiotic resistance: there is a price to pay

Thomas G Slama

• Correspondence: Thomas G Slama slamaidi@aol.com

Author Affiliations

Indiana University School of Medicine, 8240 Nabb Road #300, Indianapolis, Indiana 46260, USA

Critical Care 2008, 12(Suppl 4):S4 doi:10.1186/cc6820

Published: 21 May 2008

Abstract

Resistance rates are increasing among several problematic Gram-negative pathogens that are often responsible for serious nosocomial infections, including Acinetobacter spp., Pseudomonas aeruginosa, and (because of their production of extended-spectrum β-lactamase) Enterobacteriaceae. The presence of multiresistant strains of these organisms has been associated with prolonged hospital stays, higher health care costs, and increased mortality, particularly when initial antibiotic therapy does not provide coverage of the causative pathogen. Conversely, with high rates of appropriate initial antibiotic therapy, infections caused by multiresistant Gram-negative pathogens do not negatively influence patient outcomes or costs. Taken together, these observations underscore the importance of a 'hit hard and hit fast' approach to treating serious nosocomial infections, particularly when it is suspected that multiresistant pathogens are responsible. They also point to the need for a multidisciplinary effort to combat resistance, which should include improved antimicrobial stewardship, increased resources for infection control, and development of new antimicrobial agents with activity against multiresistant Gram-negative pathogens.