Think (Gram) negative! 英文参考文献.docVIP

Huttner and Harbarth Critical Care 2010,14:171 /content/14/3/171 COMMENTARY Think (Gram) negative! Benedikt Huttner and Stephan Harbarth* See related research by Meyer et al., /content/14/3/R113 of multidrug resistant Gram-negatives [5,6]. Carba- penems on the other hand are ? rst-line drugs for the treatment of infections due to ESBL-producing bacteria. It is tempting to assume that overuse of ? uoro quinolones and 3GC antibiotics contributed to the observed increase in ESBL producers, which subse quently increased carbapenem use. Abstract The increasing prevalence of multiresistant Gram- negative bacteria of the Enterobacteriaceae family in Europe is a worrisome phenomenon. Extended- spectrum betalactamase-producing Escherichia coli strains are widespread in the community and are frequently imported into the hospital. Of even more concern is the spread of carbapenem-resistant strains of Klebsiella spp. from regions where they are already endemic. Antibiotic use is a main driver of antibiotic resistance, which again increases broad spectrum antibiotic use, resulting in a vicious circle that is di?cult to interrupt. The present commentary highlights important ?ndings of a surveillance study of antimicrobial use and resistance in German ICUs over 8 years with a focus on Gram-negative resistance. e ecological nature of the data, however, makes it di? cult to infer clear cause-and-e? ect relationships [7], as does the failure to di? erentiate between hospital- and community-acquired isolates and clinical versus sur- veillance cultures [8]. In addition, the analysis of trends is hampered by variation in the number of participating ICUs over time. Nevertheless, the increased burden of multidrug-resistant Gram-negative bacteria is a real phenomenon. In contrast to MRSA, ESBL producers - notably strains of Escherichia coli carrying plasmids of the CTX-M In a recent issue o