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

Review

The role of carbapenems in initial therapy for serious Gram-negative infections

James J Rahal^1,2

¹Infections Disease Section, New York Hospital Queens, 56-95 Main Street, Flushing, NY 11355, USA

²Weill Cornell Medical College, 425 East 61st Street, New York, NY 10021, USA

author email corresponding author email

Critical Care 2008, 12(Suppl 4):S5doi:10.1186/cc6821

Published:	21 May 2008

Abstract

The treatment of patients with serious Gram-negative infections must be both prompt and correct. Numerous studies have demonstrated that mortality risk is significantly increased when the initial antibiotic regimen does not adequately cover the infecting pathogen. Furthermore, changing to an appropriate regimen once culture results are available does not reduce this risk. Therefore, one must empirically treat serious infections with a regimen that covers likely pathogens. Selecting such a regimen is complicated by the increasing prevalence of resistance to commonly used antibiotics. Moreover, multidrug-resistant pathogens, once limited to hospital-acquired infections, are increasingly being detected in community-acquired infections, especially those involving the urinary and gastrointestinal tracts or in immunocompromised patients. Consequently, the initial antibiotic regimen must have a broad spectrum of activity that includes potential resistant pathogens, as indicated by the local antibiogram. Many multidrug-resistant pathogens remain susceptible to carbapenems despite increasing worldwide antibiotic resistance. This article reviews the role played by carbapenems in the initial treatment of serious Gram-negative infections and the potential effect of emerging resistance on this role.