The Real Crisis in Antimicrobial Resistance: Failure to Anticipate and Respond
Robert A. Bonomo, Federico Pérez, Andrea M. Hujer, Kristine M. Hujer, Alejandro J Vila
Abstract
Encountering multidrug-resistant (MDR) Gram-negative infections in critically ill patients has become an all-too-common occurrence in healthcare settings.Increasingly, clinicians are faced with pathogens that are "untreatable," forcing them to design or implement novel or unproven combinations of antibiotics to address treatment dilemmas.In most cases, these untreatable pathogens possess a wide variety of resistance determinants that when combined create an "antimicrobial resistance nightmare".Notably, the most problematic phenotypes include carbapenem resistance mediated by the expression of metallo-β-lactamases (eg, NDM, IMP, VIM, or L1) and/or serine carbapenemases (eg, KPC, OXA-23, OXA-24, or OXA-48).Oxyimino-cephalosporin resistance can be manifested in Gram-negative bacteria by inducible chromosomal cephalosporinases (eg, AmpCs like P99 and CMY-2) and extended-spectrum β-lactamases (eg, CTX-M-15 ESBLs).In the company of numerous aminoglycoside modifying