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Antibacterial and Antifungal Agents: The Challenges of Antimicrobial-Resistant Infections in Immunocompromised Hosts

  • Matthew W. McCarthy
  • Thomas Baker
  • Michael J. Satlin
  • Thomas J. Walsh
Chapter

Abstract

Antimicrobial resistance may be intrinsic or acquired and is associated with poor clinical outcomes and breakthrough infections during treatment and prophylaxis. Given their frequent healthcare exposure, the immunocompromised are at higher risk for infection attributed to multidrug-resistant organisms. This increased risk, combined with identification through culturing techniques that can take several days, may lead to immunocompromised patients being placed empirically on antibiotics and antifungal agents that are not active against resistant organisms. Thus, patients with resistant infections may experience significant delays in receiving appropriate antimicrobial therapy. Understanding the underlying mechanisms of antibiotic resistance is critical to both choosing appropriate active therapy and developing new antimicrobial agents. Resistance mechanisms, which will be reviewed below, are extensive and vary across species. The most common mechanisms include alteration of drug target site, enzymatic drug inactivation, decreased bacterial membrane permeability, and drug efflux.

Keywords

Carbapenem Beta-lactam Beta-lactamase Neutropenia Triazole Echinocandin Polyene 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Matthew W. McCarthy
    • 1
  • Thomas Baker
    • 1
  • Michael J. Satlin
    • 1
  • Thomas J. Walsh
    • 1
  1. 1.Department of Infectious DiseasesWeill Cornell MedicineNew YorkUSA

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