Richard Whitley, MD, FIDSA
IDSA President

Sadly, the deaths and suffering caused by antibiotic-resistant infections continue to rise around the world, highlighting the urgent need for action. One of the most critical needs is the development of new antibiotics, including those to treat Gram-negative bacterial infections, caused by the “Red Bugs” Dr. Srinivasan discussed in his previous posts.

Recognizing the dangerous imbalance between the dwindling drug pipeline and the need for new antibiotics, the Infectious Diseases Society of America (IDSA) is urging a global commitment to develop 10 new antibiotics by 2020, known as the 10 x ’20 initiative. You can help us in this important effort.

Dr. Arjun Srinivasan

So, you find yourself in the horrible situation of having a patient with a Gram-negative infection.  Increasingly, clinicians are getting back reports from the microbiology lab showing pathogens that are resistant to every antibiotic they would normally use to treat a patient.  What do you do when this happens?

First, immediately implement contact precautions (such as gloves and gowns).  Secondly, in some cases you should do active surveillance among the patients who are epidemiologically linked to the case-patient.  By conducting active surveillance, you can identify additional patients colonized with these organisms.  This can help you determine whether you have ongoing patient-to-patient transmission of these bacteria in your facility.   If you detect transmission—meaning that you identify cases among patients with epidemiologic links to your case-patient—vigorously reinforce infection prevention measures until no new cases are identified.

Gram stain image is available from the Public Health Image Library (PHIL)

Dr. Arjun Srinivasan

As an infectious disease physician who has investigated numerous outbreaks, there are few pathogens that give me pause anymore.   However, Gram-negative bacteria are different.

Best known by the name “Gram negatives” (due to the red color they turn in the laboratory when a Gram stain is used), the most threatening ones include Acinetobacter, Klebsiella, Pseudomonas, and Escherichia.  These bugs have inherent genetic weapons that make them particularly good at finding new ways to be resistant to antimicrobial drugs.  Gram-negatives have often proven to be more deadly than their Gram-positive counterparts, such as MRSA.  Even scarier, there are no new drugs to treat these bacteria coming anytime soon.