This activity features a replay of a live symposia held following IDWeek 2016 in New Orleans, Louisiana.
Today it is realistic to ask whether the antibiotic era is coming to an end – as foreshadowed by Sir Alexander Fleming as early as 1943. Among all of the bacterial resistance problems, gram-negative pathogens are particularly worrisome, and treating infections of either pan-resistant or nearly pan-resistant gram-negative microorganisms is an increasingly common challenge in many hospitals.
Characterized by the CDC as an Urgent Threat Level, Carbapenem-resistant Enterobacteriaceae (CRE) have emerged as a global threat and has been labeled as one of the three greatest threats to human health by the World Health Organization. A recent study in the US showed that the rate of CRE detection in community hospitals is rapidly and significantly increasing – more than five-fold in a network of community hospitals from 2008-2012.
CRE were identified in every surveillance site in the Multi-site Gram-negative Surveillance Initiative network with incidence rates in some regions high enough to suggest that CRE are endemic. And perhaps most worrisome, the emergence of MCR-1 heralds the breach of the last group of antibiotics, polymyxins, by plasmid-mediated resistance. With the advent of transmissible colistin resistance, progression of Enterobacteriaceae from extensive drug resistance to pan-drug resistance is inevitable and will ultimately become global.
Practitioners must not base immediate future practice on the assumption that new classes of antibiotics will emerge. At least for the foreseeable future, we will just have improvements on existing agents/classes. It is imperative that clinicians understand the profile of these agents that have been recently and are soon to be approved and how they fit into the current treatment paradigms in order to optimize treatment. Examples include a re-formulation of an old agent, minocycline, the addition of new beta-lactamase inhibitors avibactam and tazobactam to established beta-lactam antibiotics, and synthetic/engineered analogs of current classes such as the aminoglycoside plazomicin.