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David P. Nicolau, Bugs versus drugs: What is the pharmacist’s challenge?, American Journal of Health-System Pharmacy, Volume 65, Issue 9_Supplement_2, 1 May 2008, Pages S2–S3, https://doi.org/10.2146/ajhp080074
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In this era of escalating bacterial resistance and more challenging and complicated infections, the collaboration among healthcare team members has become extremely important. The necessity for appropriate antimicrobial utilization has grown dramatically, as has the role of the clinical pharmacist in this arena.
When analyzing the challenges of infectious diseases, consideration must be given to three key aspects: the host, the pathogen, and the drug. Only by recognizing and understanding the interactions of these three aspects can rational decisions be made regarding appropriate antimicrobial selection. This has become even more critical as today’s hospitalized patients commonly present with multiple comorbidities that complicate diagnosis and treatment options. Furthermore, the use of surgical or invasive medical interventions can compromise or bypass the host immune system leaving the patient vulnerable to infection, thus contributing to poor outcomes.
Resistance and multidrug resistance have become endemic in U.S. hospitals, particularly in intensive care units, which severely limit effective antimicrobial selection.1 Among gram-positive bacteria, methicillin-resistant Staphylococcus aureus (MRSA) infections have been widely publicized during the past few years, particularly with an increase in MRSA infections occurring outside of the hospital in patients with no traditional risk factors for these infections. Recent studies are now showing less differentiation between healthcare-associated MRSA and community-associated MRSA infections, which can further complicate treatment selection.2,3 Multidrug-resistant gram-negative bacterial infections are also being recognized as a major threat in hospitalized patients. An initiative by the Infectious Diseases Society of America (IDSA) has identified several gram-negative bacteria that present a major threat due to lack of new antimicrobial agents under development that target these organisms.4 These include Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum β-lactamase-producing Enterobacteriaceae, such as Klebsiella pneumoniae and Escherichia coli. Successful management of patients with infections due to these bacteria will require appropriate antimicrobial selection together with optimized dosing to achieve clinical efficacy while also minimizing the risk of resistance emergence.
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