Antimicrobial resistance (AMR) in gram-negative bacteria (GNB) is persisting to be a significant cause of severe infections across the world, with increasing morbidity and mortality rates. Extended spectrum beta lactamase (ESBL) rates are alarmingly increasing in Escherichia and Klebsiella species, which is about 70% and there has been an increase in the resistance to carbapenems over the past few years in India. Current scenario of rapidly growing multidrug resistant (MDR) organisms in our Indian intensive care units is posing difficulties with regard to detecting these infections and starting appropriate empirical antibiotics. A clear understanding of the epidemiological, microbiological, and pharmacological aspects of these MDR gram-negative organisms is very important. This article tries to brief the risk factors for MDR GNB infections, spectrum of MDR GNB infections, mechanisms of resistance, and beta-lactamase enzyme classification and outlines the clinically important types and the treatment considerations for these MDR gram-negative organisms.
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