Again, however, drugs that are used must...

Gram-negative bacteria on the roots of about 30% of nosocomial infections in the United States, researchers said. Although they do not constitute the majority of these types of infections, they are "of particular concern", including effective methods for preparing medicines, and a number of mechanisms of resistance, according to Anton Peleg, MD, and David Hooper , MD, a Massachusetts General Hospital in Boston. These elements combined with the lack of new drugs, creating a "perfect storm" around the gram-negative pathogens, they said, in a review article in the May 13 issue of

New England Journal of Medicine. Gram-negative bacteria predominate players ventilator-associated pneumonia and urinary tract infections - 47% and 45% respectively - and rates 70% for both in intensive care units, they say. Ventilator-associated pneumonia is between 10% and 20% of patients on machines for more than 48 hours, and Peleg said Hooper. This condition is associated with a significant increase in length of hospital stay, mortality and costs. Key multidrug-resistant Pseudomonas aeruginosa players,

Acinetobacter baumannii, and Enterobacteriaceae producing extended spectrum or-lactamase (ESBL) or carbapenemase. There are also reports of organisms resistant to all available antibiotics, say researchers. And doctors should be aware of recent clinical entities: health care-associated pneumonia. This pneumonia when the patient has a direct or indirect contact with a doctor or long term care facility. When such patients are subsequently admitted that they often have coexisting diseases and get ineffective empirical therapy. Their risk of death is higher than in patients with true pneumonia, say researchers. "The diagnosis of ventilator-associated pneumonia remains difficult," say the researchers, and there is no "easy to get a pattern." In addition to clinical criteria, therapy should be based on an assessment of microbiological, they added. The vast majority of urinary tract infections associated with urethral catheterization, say the researchers, as well as the most effective management simply remove the catheter. Here

E. coli is a key player, then

P. coli, Klebsiella species and species of Enterobacteriaceae

A. baumannii, they said. Gram-negative bacteria also play an important role in blood infections - about 30% of cases in intensive care units due to one or another kind of Klebsiella,

Escherichia coli, Enterobacteriaceae species and P. >> << Sticks. However, Peleg and Hooper said, "including adequate portal entrance, almost all gram-negative organism can cause infection of blood flow."

Last problem facing doctors in these cases were spread carbapenemase producing Enterobacteriaceae, they said they had been found in 20 states. In both infections and blood flow ventilator-associated pneumonia, rapid provision of appropriate antibiotics improves the results, say researchers. Indeed, such a delay in therapy associated with increased mortality in cases of blood infection. Physicians should be aware of the local microbial ecology - types of resistant bacteria - and bear in mind when prescribing empirical therapy of pneumonia or infections of the blood flow, Peleg said Hooper. "It is important to know the local antimicrobial sensitivity to a direct empirical antibiotic therapy can not be overstated," they said. There remains debate about the value of combinations of drugs, but also for empirical therapy is growing, that combination therapy increases the likelihood that at least one active drug is given, they said. Again, however, drugs that are used must be adapted to local conditions, they said. "We recommend that institutional individual combination therapy for empirical treatment of serious nosocomial Gram-negative infections, and de-escalation monotherapy buy strattera once the susceptibility have been identified."