The Changing Gram-Negative Landscape


In episode 1 of this short video series, a clinician discusses his experience in what his institution is seeing as well as how they handle their treatment protocol and stewardship where possible.

The fallout from COVID-19 continues to show itself in a variety of ways affecting other areas within medicine. One specific example is antimicrobial-resistant (AMR) infections. 

The Centers for Disease Control and Prevention (CDC) released a report earlier this year titled, COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022, and in the report they concluded AMR infections worsened with resistant hospital-onset infections and deaths both increasing at least 15% during the first year of the pandemic.

The federal agency looked at AMR, and the alarming increase in resistant infections starting during hospitalization, grew among seven pathogens and increases in specific pathogens including:

  • carbapenem-resistant Acinetobacter; causing a 78% increase in infections
  • multidrug-resistant Pseudomonas aeruginosa causing a 32% increase in infections,
  • vancomycin-resistant Enterococcus (VRE); causing a 14% increase in infections, and
  • methicillin-resistant Staphylococcus aureus (MRSA); causing a 13% increase in infections.

Christian Sandrock, MD, MPH, FCCP is vice chair for Quality and Safety; division vice chief of Internal Medicine; director of Critical Care; and professor of Medicine at UC Davis Medical Center can attest to an increase in carbapenem-resistance at his institution.

“The biggest one that is concerning us is carbapenem-resistance among the gram-negatives, and that has increased,” Sandrock stated. “We are a teaching institution and we had a lot of patients who were with us for a while early on in COVID on mechanical ventilation, on ECMO [Extracorporeal membrane oxygenation]; therefore you get multiple courses of antimicrobials, as such we saw resistance increasing.”

Contagion is introducing a short series of video interviews to discuss these pathogens, and Sandrock sat down in a far-ranging interview to discuss how his institution is handling treatment, protocols on about hospital-acquired bacterial pneumonia and ventilator- associated bacterial pneumonia (HABP/VABP), and his perspective on the therapy pipeline.

In this episode, Sandrock discusses what his institution is experiencing and their microbiology resources and how it affects treatment protocols and stewardship.

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