There is an urgent need for increased efforts in antibacterial stewardship

The growing worldwide prevalence of antibiotic-resistant Gram-negative bacterial infections is alarming and needs immediate attention1

Increases of these infections have been seen in Southeast Asia, the Asia-Pacific region, the Middle East, and Latin America.2,3,4,5

  • Three of the most common pathogens in the world account for approximately 70% of all Gramnegative healthcare-associated infections (HAI). Some of these pathogens have already developed resistance to more than one drug1,6,7,8
  • Rates of Pseudomonas aeruginosa resistance to fluoroquinolones, aminoglycosides, and carbapenems are increasing within the 30 member countries of the European Antimicrobial Resistance Surveillance Network (EARS-Net)9
  • Rates of Escherichia coli resistance to fluoroquinolones and third-generation cephalosporins exceed 50% in countries within 5 of the 6 World Health Organization regions6
  • Rates of Klebsiella pneumoniae resistance to fluoroquinolones, third-generation cephalosporins, and carbapenems are high in EARS-Net countries9

Inappropriate selection, overuse, and misuse of antibiotics have resulted in a drastic increase in antibiotic-resistant Gram-negative pathogens worldwide11




1. Ruppe E, Woerther PL, Barbier F. Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care. 2015;5(21):1-15.

2. Suwantarat N, Carroll KC. Epidemiology and molecular characterization of multidrugresistant Gram-negative bacteria in Southeast Asia. Antimicrob Resist Infect Control. 2016;5:15.

3. Jean SS, Coombs G, Ling T, et al. Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010- 2013. Int J Antimicrob Agents. 2016;47(4):328-334.

4. Morrissey I, Lob S, Badal R, et al. Antimicrobial susceptibility and multi-drug resistance in the Middle East: SMART 2012-2014. Poster presented at: Gulf Congress of Clinical Microbiology and Infectious Disease 2016 (GCCMID); May 4-7, 2016; Dubai, United Arab Emirates.

5. Labarca JA, Salles MJ, Seas C, Guzman-Blanco M. Carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii in the nosocomial setting in Latin America. Crit Rev Microbiol. 2016;42:276-292.

6. State of the World's Antibiotics 2015. Center for Disease Dynamics, Economics & Policy (CDDEP): Washington, DC.

7. O'Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance. 2014.

8. Krzowska-Firych J, Kozłowska A, Sukhadia T, Al-Mosawi LK. Hospital-acquired infections caused by antibiotic resistant bacteria. Post-py Nauk Medycznych. 2014.

9. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2015. Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). 2017:1-102.

10. Chelazzi C, Pettini E, Villa G, De Gaudio AR. Epidemiology, associated factors and outcomes of ICU-acquired infections caused by Gram-negative bacteria in critically ill patients: An observational, retrospective study. BMC Anesthesiol. 2015;15:125.

11. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40:277-283.