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Vol. 46. Issue 6.
Pages 326-335 (June 2022)
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Vol. 46. Issue 6.
Pages 326-335 (June 2022)
SERIE: multi-resistant gram-negative bacilli
The problem of multi-resistance in gram-negative bacilli in intensive care units: Treatment and prevention strategies
El problema de la multi-resistencia en bacilos gram-negativos en las unidades de cuidados intensivos: estrategias de tratamiento y prevención
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J. Garnacho-Monteroa,
Corresponding author
jgarnachom@gmail.com

Corresponding author.
, R. Amaya-Villarb
a Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract

The rise of infections caused by multi-resistant gram-negative bacilli (MR-GNB), which includes carbapenems, represents one of the major current challenges worldwide. These MR-GNB include extended spectrum β-lactamase-producing Enterobacterales, derepressed AmpC-producing or carbapenemase-producing Enterobacterales as well as non-fermenting Gram-negative bacilli such as Pseudomonas aeruginosa or Acinetobacter baumannii. P. aeruginosa predominantly exhibits other resistance mechanisms different to β-lactamases such as expulsion pumps or loss of porins. A. baumannii frequently presents several of these resistance mechanisms. Mortality is high especially if empirical treatment is inadequate. In this review, treatment strategies are revised, describing the tools available to identify patients in whom empirical antibiotic treatment would be justified to cover MR-GNB, the importance of optimizing the administration of these antibiotics, as well as prevention strategies to avoid its spread from patients colonized or infected by a MR-GNB.

Keywords:
Gram-negative bacilli
Multi-drug resistant bacteria
Carbapenemase
Extended spectrum beta-lactamase
Resumen

El aumento global de infecciones causadas por bacilos gram-negativos multi-resistentes (BGN-MR), lo cual incluye a los carbapenemes, supone uno de los grandes retos actuales en materia de sanidad. Esto incluye Enterobacterales productores de β-lactamasas de espectro extendido, productoras de AmpC desreprimida o Enterobacterales productores de carbapenemasas, así como BGN-MR no fermentadores como Pseudomonas aeruginosa o Acinetobacter baumannii. En Pseudomonas aeruginosa predominan otros mecanismos de resistencias diferentes a las β-lactamasas tales como bombas de expulsión o pérdida de porinas. A. baumannii presenta con frecuencia varios de estos mecanismos de resistencia. La mortalidad es elevada especialmente si el tratamiento empírico es inadecuado. En este capítulo se revisan las estrategias de tratamiento haciendo hincapié en las herramientas para identificar los pacientes en los que estaría justificado tratamiento antibiótico empírico para cubrir BGN-MR, la importancia de la optimización de la administración de estos antibióticos, así como las estrategias de prevención para evitar su diseminación desde pacientes colonizados o infectados por un BGN-MR.

Palabras clave:
Bacilos gram-negativos
Bacterias multi-resistentes
Carbapenemasas
Beta-lactamasas de espectro extendido

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