DOI: 10.25934/pr00009017
title: Data Challenge - Gram Negative Pathogen and Antimicrobial resistance 

description: Aerobic gram-negative pathogen, including the family of Enterobacteriaceae and non-lactose fermenting bacteria such as Pseudomonas and Acinetobacter species, are major causes of hospital-acquired infections. The rate of antibiotic resistance among these pathogens in recent years and has reached pandemic scale. In this review, we provide a summary of the major classes of gram-negative bacilli and their key mechanisms of antimicrobial resistance, discuss approaches to the treatment of these difficult infections, and outline methods to slow the further spread of resistance mechanism.
As a group, aerobic gram-negative bacilli are the most common causes of nosocomial infections and the most common causes of infection in the ICU, including most cases of hospital-acquired pneumonia and urinary tract infections and 25% to 30% of bloodstream and surgical site infections. A subset of gram-negative bacilli, the Enterobacteriaceae are part of the normal commensal flora of the human gut and, in the context of acute illness, asymptomatically colonize the upper aerodigestive tract and skin in most hospitalized patients and nearly all critically ill individuals. Once established as colonizers, these organisms cause hospital-acquired infections from microaspiration or their introduction into sterile sites; in addition, the colonizing bacteria are progressively displaced by antibiotic-resistant strains in the ICU setting. 
Antibiotic stewardship (AS) improves patient outcomes and rates of antibiotic susceptibilities. However, the long-term effect of AS programs (ASPs) on mortality is unclear. This study aimed to assess the impact of bedside interventions by an AS team (AST) on clinical and microbiological outcomes. This retrospective study enrolled patients with bloodstream infections (BSI) and long-term use of broad-spectrum antibiotics (more than 7 days). The main outcomes were 30-day and in-hospital mortality of patients with BSI. The secondary outcomes were the day of therapy (DOT) and susceptibility of antipseudomonal agents.
Reduce the pool of patients susceptible to nosocomial infections. This can be achieved by implementing ICU practices that minimize the use of indwelling vascular lines, GI tubes, and urinary catheters and enforcing strict sterile technique during procedures. Prevent transmission in the hospital environment. This requires good general hygiene practices such as hand washing and decontaminating equipment between patients, systematic monitoring for antibiotic resistant bacteria. Develop novel antimicrobials. Policies that prioritize antibiotic research at universities and provide financial incentives for research and development to the pharmaceutical industry have the potential to stimulate the development of new antibiotic classes.
Antimicrobial resistance jeopardizes advancements in modern health care that we have come to rely on, such as joint replacements, organ transplants, and cancer therapy. These procedures have a significant risk of infection, and patients won't be able to receive them if effective antibiotics are not available.