Multi-Drug Resistant Gram-Negative Microorganisms: Epidemiology, Treatment and Alternative Approach

Dear Colleagues,

Infections caused by multidrug-resistant (MDR) Gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae, especially carbapenem-resistant Klebsiella pneumoniae (CR-KP), constitute an important issue for establishing a correct and appropriate therapy. Outbreaks due to KPC (K. pneumoniae carbapenemase) have been detected in many countries around the world; indeed, these infections have become endemic not just in Europe but also in the United States, Israel, and China. KPC is an important mechanism of resistance for an increasingly wide range of Gram-negative bacteria. Reducing the spread of resistant pathogens, other than reducing the rate of resistance evolution, is a complex task to be achieved. Therapeutic regimens currently available are encountering several problems due to the diffusion of multidrug resistance. Old antibiotics such as colistin and fosphomycin in combination with other antibiotics should be evaluated. New antibiotics such as tigecycline, ceftolozane–tazobactam, aztreonam–avibactam, cefiderocol, ceftazidime–avibactam, meropenem–vaborbactam, eravacycline and plazomicin should be taken into account. It would be desirable to look for any alternative approach, specifically the use of antimicrobial peptides that interact with the anionic Gram-negative cell wall because of charge electrostatic or the use of medicinal oils, antibodies, common biocides, killing factors, drugs with antibacterial activity different from antibiotics and even phage therapy.

Dr. Maria Mascellino
Guest Editor

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