The new treatment paradigm and the role of carbapenems

Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: Predictors and molecular epidemiology

“…Indeed, the use of this class of antibiotics varies considerably among countries, hospitals, units, depending on the microbial ecology. [26] Moreover, the low number of CR-GNB cases included can also explain this result.…”

Multidrug-resistantPseudomonas aeruginosaandAcinetobacter baumannii: resistance mechanisms and implications for therapy

“…From a clinical perspective, MDR P. aeruginosa and A. baumannii isolates that present resistance to carbapenems represent the most challenging pathogens, since carbapenems are the most potent agents against these organisms and are usually prescribed as the last resort treatment for many Gram-negative infections [142]. Of particular concern are the isolates showing carbapenem resistance due to enzymatic mechanisms, that is, carbapenemase production.…”

“…Carbapenems are the drugs of choice for the treatment of severe infections caused by MDR AmpC-or ESBL-producing P. aeruginosa and A. baumannii, since most enzymes marginally affect imipenem and meropenem [142]. For isolates showing in vitro resistance to all b-lactams, except carbapenems, these Review Multidrug-resistant Pseudomonas aeruginosa & Acinetobacter baumannii drugs can usually be safely used, but the determination of the MIC could improve our ability to infer the presence of other nonenzymatic resistance mechanisms that may potentially affect the activity of these agents.…”

Patterns of antimicrobial therapy in severe nosocomial infections: empiric choices, proportion of appropriate therapy, and adaptation rates—a multicentre, observational survey in critically ill patients

“…This concept, often referred to as 'de-escalation', is widely used and advocated [37][38][39][40]. This strategy has been shown to be successful and safe, and may also reduce antibiotic use and hence limit the emergence of MDR [36,41].…”