Multidrug-resistant bacteria: what is the threat?

Hematology Am Soc Hematol Educ Program. 2013;2013:428-32. doi: 10.1182/asheducation-2013.1.428.


Despite big advances in antimicrobial therapies and infection strategies, the emergence of antibiotic resistance represents an emergency situation, especially in immunocompromised hosts. Specifically, infections due to multidrug resistant, gram-negative pathogens are responsible for high mortality rates and may leave few effective antimicrobial options. Furthermore, although new compounds are available for severe methicillin-resistant staphylococcal infections, there is a paucity of novel classes of antimicrobials to target resistant gram-negatives. A careful assessment of the clinical conditions and underlying comorbidities, along with knowledge about the previous history of colonization or infections due to multidrug-resistant bacteria, represent key points in approaching the hematological patient with signs of infection. A de-escalation therapy with initial use of wide-spectrum antimicrobials followed by a reassessment after 72 hours of treatment may represent a good option in severe infections if a resistant pathogen is suspected. Prompt empiric or targeted therapy using combination regimens (ie, antipseudomonal beta-lactam plus an aminoglycoside or a quinolone) with the addition of colistin, along with increased dosage and therapeutic drug monitoring, represent options for these life-threatening infections. Continuous epidemiological surveillance of local bacteremias is necessary, along with stringent enforcement of antibiotic stewardship programs in cancer patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy
  • Bacteremia / etiology
  • Bacteremia / mortality
  • Drug Resistance, Multiple, Bacterial*
  • Drug Therapy, Combination
  • Humans
  • Immunocompromised Host*
  • Methicillin-Resistant Staphylococcus aureus*
  • Neoplasms / complications
  • Neoplasms / mortality
  • Neoplasms / therapy
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / mortality


  • Anti-Bacterial Agents