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Contemporary Reviews in Critical Care Medicine |

Antimicrobial Resistance in Hospital-Acquired Gram-Negative Bacterial InfectionsGram-Negative Antibiotic Resistance

Borna Mehrad, MBBS; Nina M. Clark, MD; George G. Zhanel, PhD; Joseph P. Lynch, III, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine and The Carter Center for Immunology (Dr Mehrad), University of Virginia, Charlottesville, VA; the Division of Infectious Diseases (Dr Clark), Department of Medicine, Loyola University, Maywood, IL; the Department of Medical Microbiology and Infectious Diseases (Dr Zhanel), University of Manitoba, Winnipeg, MB, Canada; and the Division of Pulmonary and Critical Care Medicine (Dr Lynch), David Geffen School of Medicine at UCLA, Los Angeles, CA.

CORRESPONDENCE TO: Joseph P. Lynch III, MD, 37-131 Center for Health Sciences, 10833 Le Conte Ave, Los Angeles, CA 90095-1690; e-mail: jplynch@mednet.ucla.edu


FUNDING/SUPORT: This study was supported by the National Institutes of Health [Grants HL098526 and HL09832].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1413-1421. doi:10.1378/chest.14-2171
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Aerobic gram-negative bacilli, including the family of Enterobacteriaceae and non-lactose fermenting bacteria such as Pseudomonas and Acinetobacter species, are major causes of hospital-acquired infections. The rate of antibiotic resistance among these pathogens has accelerated dramatically in recent years and has reached pandemic scale. It is no longer uncommon to encounter gram-negative infections that are untreatable using conventional antibiotics in hospitalized patients. In this review, we provide a summary of the major classes of gram-negative bacilli and their key mechanisms of antimicrobial resistance, discuss approaches to the treatment of these difficult infections, and outline methods to slow the further spread of resistance mechanisms.


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