Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns

Abstract

Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future.

Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action

“…Pneumonia represents a serious public health issue that is associated with high medical burden and substantial economic costs, in addition to hospitalizations and mortality in individuals of all age groups [ 10 ]. Herein, we studied hospitalizations and in-hospital mortality in patients with main and secondary diagnoses of pneumonia in Italy over a 10-year period spanning 2010–2019.…”

Effects of Aerosol Inhalation Combined with Intravenous Drip of Polymyxin B on Bacterial Clearance, Symptoms Improvement, and Serum Infection Indexes in Patients with Pneumonia Induced by Multidrug-Resistant Gram-Negative Bacteria

“…Controlling bacterial infection and killing the activity of pathogenic bacteria are the principles of medication for the treatment of MDR Gram-negative ( G −) bacterial pneumonia [ 10 ]. The results of this study showed that after treatment, the total bacterial clearance rate of the observation group was 90.14%, which was significantly higher than that of the control group, which was 77.61%, and the time for body temperature to return to normal, the time for disappearing rales, the time for leukocyte recovery, and the time for X-ray recovery in the observation group were shorter than the control group.…”

“…Controlling bacterial infection and killing the activity of pathogenic bacteria are the principles of medication for the treatment of MDR Gram-negative (G−) bacterial pneumonia [10].…”

β-Lactam Dosing in Critical Patients: A Narrative Review of Optimal Efficacy and the Prevention of Resistance and Toxicity

“…Outbreaks of such bugs in hospital settings, particularly in intensive care units and hematological or surgical wards, are especially cumbersome. In addition, there are already reports of panresistant microbes in community settings, which, together with hospital dissemination, present significant biosafety issues [ 127 ].…”