MD Conference Express ATS 2011 - (Page 18)
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Multidrug-Resistant Pulmonary Pathogens: Controlling a Major Public Health Risk
Written by Anne Jacobson
Multidrug-resistant lung infections are increasingly common in vulnerable patient populations, including patients with tuberculosis and cystic fibrosis and the critically ill. In this session, chaired by Samuel M. Moskowitz, MD, Massachusetts General Hospital, Boston, MA, USA and Keertan Dheda, MBChB, PhD, University of Cape Town, Cape Town, South Africa, presenters discussed new approaches to the diagnosis and management of antibiotic-resistant pulmonary pathogens, including the use of first-line combination antibiotic therapy and novel drug delivery. Emerging Multidrug-Resistant Pathogens Gram-negative bacteria are increasingly resistant to conventional antibiotics, including beta-lactams, fluoroquinolones, and aminoglycosides. Multidrug-resistant gram-negative bacteria thrive in part because of mobile genes on plasmids that spread readily through bacterial populations. The widespread and inappropriate use of nonprescription antibiotics, particularly the carbapenems, increases the numbers of drug-resistant bacterial clones through selective pressure. One recent example is the blaNDM-1 gene, which encodes New Delhi metallo-betalactamase-1 (NDM-1), an enzyme that is expressed by Enterobacteriaceae and confers resistance to a broad range of beta-lactam antibiotics. Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae, are among the most common causes of serious nosocomial and community-associated bacterial infections. NDM-1 was first detected in 2008 in a K. pneumoniae isolate that was recovered from a Swedish patient in a hospital in New Delhi, India, and has since been detected in E. coli and K. pneumoniae isolates in India, Pakistan, Bangladesh, and the United Kingdom [Kumarasamy KK et al. Lancet Infect Dis 2010]. The sudden and widespread presence of NDM-1-encoding plasmids suggests an alarming new mechanism for antimicrobial resistance. Without aggressive infection control measures, the medical community may face multidrug-resistant Enterobacteriaceae that cause common respiratory infections, resulting in treatment failures and substantial increases in health care costs. Extensively drug-resistant tuberculosis (XDR-TB) is another multidrug-resistant pathogen that has thrived as a result of inappropriate antibiotic use. XDR-TB is resistant to established first-line drugs (isoniazid and rifampin) as well as second-line therapy with fluoroquinolones and at least one injectable agent (amikacin, kanamycin, or capreomycin). Super XDR-TB is a subtype of XDR-TB that is resistant to all known classes of anti-TB medications. In a study of South African patients with XDR-TB, 68% had isolates that were resistant to all available drugs, leaving no effective treatment options for these patients [Shah NS et al. Emerging Infect Dis 2011]. These findings highlight the importance of expanded drug susceptibility testing for second- and third-line drugs to improve diagnosis and guide treatment for patients with multidrug-resistant TB. Highlights from the
American Thoracic Society 2011 International Conference
Management of Multidrug-Resistant Infections Experience in managing well-characterized respiratory infections may provide insight on the optimal management of emerging multidrug-resistant pathogens. Pseudomonas aeruginosa is a major cause of ventilator-associated pneumonia (VAP). In a multicenter, retrospective study of 183 patients with VAP and positive respiratory cultures for P. aeruginosa, initial treatment with antibiotic monotherapy provided poor protection against resistance
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August 2011
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Table of Contents for the Digital Edition of MD Conference Express ATS 2011
MD Conference Express ATS 2011
Contents
Obesity: Implications for the Clinical Practice of the Pulmonary, Critical Care and Sleep Physician
Asthma Phenotypes: Understanding Distinct Subgroups of Asthma Patients
Evaluation of a Rifapentine-Containing Regimen for Intensive Phase Treatment of Pulmonary Tuberculosis: TBTC Study 29
Asthma Exacerbations During Pregnancy Are Reduced By Inflammatory Guided Asthma Management
TESRA Study Results
Multicenter International Lymphangioleiomyomatosis Efficacy and Safety of Sirolimus Trial
Intensive Care Physician Versus Qualified Nurse Based Critical Care Transport
Chronic Azithromycin Decreases the Frequency of COPD Exacerbations
Drug Development
Sleep Medicine
Critical Care
Advances in NSCLC
Mechanisms and Advances in COPD Therapy
MD Conference Express ATS 2011
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