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Intensive Care Medicine

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21.07.2017 | Review

Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach

verfasst von: Matteo Bassetti, Garyphallia Poulakou, Etienne Ruppe, Emilio Bouza, Sebastian J. Van Hal, Adrian Brink

Erschienen in: Intensive Care Medicine | Ausgabe 10/2017

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Abstract

Purpose

To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field.

Methods

Review of medical literature and expert opinion were used in the development of this review.

Results

There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality. In the last decade, antibiotic stewardship and infection prevention and control have been unable to prevent the rapid spread of resistant Gram-negative bacteria (GNB), in particular carbapenem-resistant Pseudomonas aeruginosa (and other non-fermenting GNB), extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE). The situation appears more optimistic currently for Gram-positive, where Staphylococcus aureus, and particularly methicillin-resistant S. aureus (MRSA), remains a cardinal cause of healthcare-associated infections worldwide. Recent advancements in laboratory techniques allow for a rapid identification of the infecting pathogen and antibiotic susceptibility testing. Their impact can be particularly relevant in settings with prevalence of MDR, since they may guide fine-tuning of empirically selected regimen, facilitate de-escalation of unnecessary antimicrobials, and support infection control decisions.

Currently, antibiotics are the primary anti-infective solution for patients with known or suspected MDR bacteria in intensive care. Numerous incentives have been provided to encourage researchers to work on alternative strategies to reverse this trend and to provide a means to treat these pathogens. Although some promising antibiotics currently in phase 2 and 3 of development will soon be licensed and utilized in ICU, the continuous development of an alternative generation of compounds is extremely important. There are currently several promising avenues available to fight antibiotic resistance, such as faecal microbiota, and phage therapy.

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Titel: Antimicrobial resistance in the next 30 years, humankind, bugs and drugs: a visionary approach
verfasst von: Matteo Bassetti
Garyphallia Poulakou
Etienne Ruppe
Emilio Bouza
Sebastian J. Van Hal
Adrian Brink
Publikationsdatum: 21.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 10/2017
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4878-x

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