Targeting antimicrobial-resistant bacterial respiratory tract pathogens: it is time to 'get smart'. Issue 3 (May 2015)

• Record Type: Journal Article
• Authors: Lee, Boeun; Boucher, Helen W.
• Is Part Of: Current opinion in pulmonary medicine. Volume 21:Issue 3(2015:May)
• Publication Date: 2015-05
• Subjects: antimicrobial resistance -- antimicrobial stewardship -- carbapenem resistance -- pathogen-directed therapy -- rapid diagnostic tests; Respiratory organs -- Diseases -- Periodicals; 616.24
• DOI: 10.1097/MCP.0000000000000157
• Languages: English
• ISSNs: 1070-5287

Abstract

Abstract : Purpose of review: Pathogen-directed therapy targeting multidrug-resistant bacteria in pneumonia can be a challenge. We reviewed the recent literature on bacterial resistance, diagnostic methods, and treatment strategies to guide pathogen-directed therapy of respiratory infections. Recent findings: Antibiotic resistance is a growing problem in both community and nosocomial settings. Macrolide resistance in Streptococcus pneumoniae varies geographically, ranging from 45 to 88%, and has been associated with prior antibiotic use. Methicillin-resistant Staphylococcus aureus and multidrug-resistant Gram-negative bacilli remain the main targets for pathogen-directed therapy in patients with hospital-acquired and ventilator-associated pneumonia. Rapid molecular tests show promise to facilitate pathogen-directed therapy. Improved antibiotic use with the right drug and optimal dose is a key strategy in tackling antimicrobial resistance. Evidence supporting de-escalation for hospital-acquired and ventilator-associated pneumonia has been increasing. To date, no convincing evidence exists to support combination therapy for severe infections due to carbapenem-resistant Gram-negative bacilli. Aerosolized therapy might provide additive benefits to parenteral therapy, but requires further study. Summary: Pathogen-directed therapy guided by in-vitro microbiological data is a safe approach for the treatment of respiratory infections due to antibacterial-resistant bacteria. Further research should focus on the role of rapid diagnostic tools, new antibiotics, and novel immunotherapy for respiratory infection.