SYMPOSIUM
• Vancomycin-resistant enterococci (VRE). Enterococci are intrinsically resistant or tolerant to many antimi- crobials, which explains why entero- coccal infections have always been recognized as a clinical challenge. The remarkable ability of these or- ganisms to modify their DNA has resulted in resistance to almost every antibiotic available, many times leav- ing clinicians with no reliable thera- peutic options. VRE cause about 20,000 U.S. infections per year.3
Im-
portantly, most of these infections oc- cur in hospitalized patients and par- ticularly in the severely debilitated, such as cancer patients, recipients of hematopoietic stem-cell transplants, or patients in the intensive care unit, complicating their clinical course and negatively impacting their out- comes.15
• Multidrug-resistant Pseudomonas spp. and Acinetobacter spp. These or- ganisms are gram-negative bacteria that are well-known for their abil- ity to develop resistance to multiple antibiotics and are a common cause of health care-associated infections such as pneumonia and urinary tract and bloodstream infections. These bacteria typically produce problems in critically ill patients and cause about 1,000 deaths combined. Out-
comes of severe Acinetobacter bau- manii infections in subgroups of pa- tients such as cancer and transplant patients are poor, with death rates that can reach up to 55 percent.16
STRATEGIES TO FACE THE CHALLENGE
Antimicrobial resistance is a multi- faceted problem, and tackling it will require the involvement of many enti- ties, including governmental agencies, professional societies, the private sec- tor, health care personnel, academic institutions, and the community as a whole. Different strategies to pre- vent the development of resistance, advancing our ability to rapidly de- tect multidrug-resistant organisms, controlling the spread of resistant
bacteria, improving the use of cur- rently available drugs, and promoting discovery and commercialization of novel antimicrobial compounds need to be implemented. The “National Action Plan for Combating Antibiotic-resistant Bac- teria,” published in March 2015 by the Obama administration, incorporates policy recommendations of the Presi- dent’s Council of Advisors on Sci- ence and Technology. It’s a roadmap for implementing a national effort to address the most urgent and serious multidrug-resistant threats that af- fect the U.S. population. The outline of this plan includes:
• Slow the emergence of resistant bacteria and prevent the spread of resistant infections. Controlling and preventing the spread of multidrug- resistant organisms is paramount to address this global crisis. Advancing our understanding of transmission dynamics and improving our infec- tion control and antimicrobial stew- ardship strategies will be crucial to achieve this goal.
• Strengthen national one-health sur- veillance efforts to combat resistance. A successful approach to cope with antimicrobial resistance will need to consider all factors included in the development of resistant bacteria, in- cluding the understanding of the role of widespread antimicrobial use in the animal and agricultural industry and the role of the environment as a reservoir of resistant traits.
• Advance development and use of rapid, innovative diagnostic tests for identification and characteriza- tion of resistant bacteria. Advancing research and development of novel rapid diagnostics will play an impor- tant role, as these strategies will al- low health professionals to improve their treatment decisions and are likely to result in better targeting of antimicrobial compounds. Rapid di- agnostics can play a crucial role in the study and control of outbreak sit- uations. Among many others, the use
FIGURE 2. ANTIBIOTIC-RESISTANT THREATS
Urgent threats • Clostridium dificile • Carbapenem-resistant Enterobacteriaceae (CRS)
• Drug-resistant Neisseria gonorrhoeae
Serious threats • Multidrug-resistant Acinetobacter
• Drug-resistant Campylobacter • Fluconazole-resistant Candida (a fungus)
• Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL)
• Vancomycin-resistant Enterococcus (VRE)
• Multidrug-resistant Pseudomonas aeruginosa
• Drug-resistant non-typhoidal Salmonella
• Drug-resistant Salmonella Typhi
• Drug-resistant Shigella • Methicillin-resistant Staphylococcus aureus (MRSA)
• Drug-resistant Streptococcus pneumoniae
• Drug-resistant tuberculosis
Concerning threats • Vancomycin-resistant Staphylococcus aureus (VRSA)
• Erythromycin-resistant Group A Streptococcus
• Clindamycin-resistant Group B Streptococcus
Source: Reproduced from oficial CDC report. Antibiotic Resistant Threats in the United States, 2013, CDC,
www.cdc.gov/drugresistance/pdf/ar- threats-2013-508.pdf
February 2017 TEXAS MEDICINE 51
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