Therapeutic Handling of Infections Caused by Difficult-to-Treat Resistance (DTR) Gram-Negative Bacterial Pathogens: Is It Feasible?

Dear Colleagues,

The rise of the 21st century coincided with the emergence of multi-drug-resistant Gram-negative bacteria, including extensively drug-resistant (XDR) carbapenemase-producing Klebsiella pneumoniae and other Enterobacterales, as well as Pseudomonas aeruginosa and pan-drug resistant (PDR) Acinetobacter baumannii. Recently, a more precise definition of resistance for Gram-negative bacilli, defined as difficult-to-treat resistance (DTR), has been proposed, indicating treatment-limiting resistance to all β-lactams and fluoroquinolones. The burden of global resistance in 2019 mounted to 4.95 million deaths, of which 1.27 million were directly attributable to bacterial antimicrobial resistance, whereas in the USA the CDC has estimated that 2.868.700 people were infected with antibiotic-resistant bacteria and fungi, resulting in 35.900 deaths each year. The constantly increasing global threat of antibiotic resistance, which has resulted in countless untreatable infections and deaths, demands the urgent need for a strategic action plan. The fact that humanity is approaching the “End of the Miracle Drugs”, due to their unjustifiable overuse and misuse, has prompted a vast concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, designed to guide rational antibiotic utilization. Furthermore, newer strategies to mitigate the existing resistance, and preventing resistance to newer compounds being developed, based on the appropriate handling of newer antibiotics, are urgently required.

Prof. Dr. Helen Giamarellou
Guest Editor

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• antibiotic stewardship
• PDR
• DTR
• Gram-negative bacilli
• newer β-lactamase inhibitors