NON-FERMENTING GRAM-NEGATIVE BACTERIA - LET'S BE CAUTIOUS
Keywords:
Non-fermenting Gram-negative bacteria, antimicrobial resistance, virulence factorsAbstract
Non-fermenting Gram-negative bacteria are a taxonomically diverse group of aerobic nonspore forming bacteria, the majority of which are able to survive for extended time periods under adverse environmental conditions - dry, cold or warm. They are widely distributed in the environment including soil, water, plants and various other sources. In the hospital environment, they may be isolated from humidifiers, ventilator machines, nebulizers, dialysis fluids, saline solution, disinfectants and medications. They can be part of the transient physiologic flora and can be also found as commensals on the human skin or in the gut. These opportunistic pathogens possess a highly variable level of virulence as a major virulence factor is the ability of biofilm production which facilitates attachment to various surfaces, resistance to phagocytic activity and other host immune factors, protection from antimicrobial activity and enhanced spread across surfaces through bacterial motility. The accurate identification of these bacteria to species level is absolutely important for appropriate patient management. The molecular methods for identification are emerging as alternatives for phenotypic identification methods of these microorganisms and have provided a number of changes in taxonomy, but also contributed important insights into their epidemiology and clinical importance. The non-fermenting Gram-negative bacteria group includes organisms from diverse genera, the most prevalent among which are Pseudomonas, Acinetobacter, Stenotrophomonas, Burkholderia, Alcaligenes, Weeksella, Flavimonas, Achromobacter, Elizabethkingia, etc. Non-fermenting Gram-negative bacteria rarely causes disease in healthy individuals. However, in recent years these bacteria have emerged as important healthcare-associated pathogens. They cause infections in critically ill, immunocompromised or cystic fibrosis patients and are particularly associated with severe urinary tract infections, wound infections, ventilator pneumonia, meningitis, surgical site infections and bloodstream infections significantly increasing morbidity and mortality among the patients. A major issue for the physicians in terms of non-fermenting Gram-negative bacteria infection treatment and control is the emerging challenges of multi-drug resistance, both intrinsic and acquired among them and the rapid emergence of resistance to novel antimicrobial compounds raises concerns about the clinical reliability of these agents which in turn leads to prolonged hospital stay and greater healthcare costs.
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