LOS ANGELES — Forty percent of infectious disease specialists named multidrug-resistant gram-negative bacilli as the greatest threat to ICU patients, among all drug-resistant organisms.
Those physicians practicing in the mid-Atlantic region expressed the most concern in the survey.
Of particular note, specialists say they are having to resort to polymyxins to treat MDR-GNB infections despite the risk of nephrotoxicity and neurotoxicity associated with such drugs, said Rebecca H. Sunenshine, M.D., of the Centers for Disease Control and Prevention in Atlanta.
“People are starting to worry a lot about 'gram-negatives,'” she said in an interview at the annual meeting of the Society for Healthcare Epidemiology of America.
The Infectious Diseases Society of America's Emerging Infections Network surveyed its members in September 2004 regarding the emergence of nosocomial infections involving MDR-GNB.
More than 60% of 440 members surveyed from throughout the United States, U.S. territories, and Canada said they had treated at least one MDR-GNB infection resistant to all antimicrobials tested except polymyxins in the previous 12 months. In the mid-Atlantic states, 76% reported seeing at least one such infection during the year.
Most reported were MDR Pseudomonas infections—2,581 reported by 197 infectious disease specialists. Next was MDR Acinetobacter—reported by 140 specialists who had seen 1,439 cases.
Just 60% of respondents said polymyxins were available in their hospitals, and only a quarter said they were on formulary. “These drugs are not universally available, and susceptibility testing for them is not routinely performed. Other antimicrobial agents should be developed to treat these resistant infections,” the investigators said.