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Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia

  • Antimicrobial Development and Drug Resistance (A Pakyz, Section Editor)
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Abstract

Purpose of Review

Hospital-acquired and ventilator-associated pneumonia (VAP) are frequent causes of infection among critically ill patients. VAP is the most common hospital-acquired bacterial infection among mechanically ventilated patients. Unfortunately, many of the nosocomial Gram-negative bacteria that cause VAP are increasingly difficult to treat. Additionally, the evolution and dissemination of multi- and pan-drug resistant strains leave clinicians with few treatment options. VAP patients represent a dynamic population at risk for antibiotic failure and under-dosing due to altered antibiotic pharmacokinetic parameters. Since few antibiotic agents have been approved within the last 15 years, and no new agents specifically targeting VAP have been approved to date, it is anticipated that this problem will worsen. Given the public health crisis posed by resistant Gram-negative bacteria, it is essential to establish a firm understanding of the current epidemiology of VAP, the changing trends in Gram-negative resistance in VAP, and the current issues in drug development for Gram-negative bacteria that cause VAP.

Recent Findings

Rapid identification technologies and phenotypic methods, new therapeutic strategies, and novel treatment paradigms have evolved in an attempt to improve treatment outcomes for VAP; however, clinical data supporting alternative treatment strategies and adjunctive therapies remain sparse. Importantly, new classes of antimicrobials, novel virulence factor inhibitors, and beta-lactam/beta-lactamase inhibitor combinations are currently in development. Conscientious stewardship of new and emerging therapeutic agents will be needed to ensure they remain effective well into the future.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, 555 31st St., Downers Grove, IL, 60515, USA

    Nathaniel J. Rhodes & Caroline E. Cruce

  2. Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA

    Nathaniel J. Rhodes & Caroline E. Cruce

  3. Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA

    J. Nicholas O’Donnell

  4. Department of Internal Medicine, Division of Pulmonary Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Richard G. Wunderink

  5. Department of Internal Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Alan R. Hauser

  6. Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Alan R. Hauser

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NJR: discloses reciept of travel expenses and honoria from American Society of Healthsystem Pharmacists

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RGW: discloses reciept of payment for continuing medical education from Medscape and consulting fees from Meiji-Seiko, Merck, Nabriva, Polyphor, Roche/Genetech, Shionogi, The Medicines Company, Accelerate Diagnostics, Curetis, and bioMerieux

ARH: discloses board membership with Microbiotix, NIH grant funding, travel funds and expenses from Cystic Fibrosis Foundation and American Society of Microbiology, and consulting fees from MedImmune

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Rhodes, N.J., Cruce, C.E., O’Donnell, J.N. et al. Resistance Trends and Treatment Options in Gram-Negative Ventilator-Associated Pneumonia. Curr Infect Dis Rep 20, 3 (2018). https://doi.org/10.1007/s11908-018-0609-x

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