Diagnosis and therapy for bacterial blood stream infection

Malleswari B

B.Malleswari Priyadarshini Institute of Pharmaceutical Education and Research, 5th mile, pulladigunta, Guntur-522017, Andhra Pradesh, India

Abstract

The rising incidence of bloodstream infections (BSI) due to Gram-negative bacteria (GNB) with di cult-to-treat resistance (DTR) has been recognized as a global emergency. The aim of this review is to provide a comprehensive assessment of the mechanisms of antibiotic resistance, epidemiology and treatment options for BSI caused by GNB with DTR, namely extended-spectrum Beta-lactamase-producing Enterobacteriales; carbapenem-resistant Enterobacteriales; DTR Pseudomonas aeruginosa; and DTR Acinetobacter baumannii Bloodstream infection (BSI) is defined by positive blood cultures in a patient with systemic signs of infection and may be either secondary to a documented source or primary—that is, without identified origin. Community‑acquired BSIs in immunocompetent adults usually involve drug‑susceptible bacteria, while healthcare‑associated BSIs are frequently due to di cult-to-treat resistance (DTR) strains. Early adequate antimicrobial therapy is a key to improve patient outcomes, especially in those with criteria for sepsis or septic shock, and should be based on guidelines and direct examination of available samples. Local epidemiology, suspected source, immune status, previous antimicrobial expo sure, and documented colonization with MDR bacteria must be considered for the choice of first‑line antimicrobials in healthcare‑associated and hospital‑acquired BSIs.. Initial antimicrobial dosing should take into account the pharmacokinetic alterations usually observed in ICU patients, with a loading dose in case of sepsis or septic shock. Source identification and control should be performed as soon as the hemodynamic status is stabilized.

Keywords: Bloodstream Infection, Gram-Negative Bacteria, Di Cult-To-Treat Resistance (DTR), Multi Drug Resistance (MDR)

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B.Malleswari