This two-stage approach of using aggressive initial therapy followed by de-escalation allows serious infection to be treated immediately and effectively avoiding antibiotic overuse, potential resistance and excessive costs. Multidrug-resistant pathogens The threat of antimicrobial resistance has been identified as one of the major challenges in the management of complicated intra-abdominal infections. Over AZD8931 price the past few decades, an increase of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa, extended-spectrum

beta-lactamase-producing Escherichia coli and Klebsiella spp., and multidrug-resistant Acinetobacter spp., has been observed, also in intra-abdominal infections. Management of severe intra-abdominal infections must always include a balance between optimizing empirical

therapy, which has been shown to improve outcomes, and reducing unnecessary antimicrobial use. Bacterial resistance is becoming a very important problem. Despite increasing antimicrobial resistance and multi-drug resistance in clinical isolates, there are GW3965 few novel antimicrobial agents in development. Some broad-spectrum agents maintain still satisfactory profiles of safety and efficacy in treatment of multidrug resistant bacteria in complicated intra-abdominal infections mafosfamide but they must be used judiciously to preserve their effectiveness against multidrug resistant pathogens. Enterococcus Enterococcus infections

are difficult to treat because of both intrinsic and acquired resistance to many antibiotics. Enterococci are intrinsically resistant to many penicillins, and all cephalosporins with the possible exception of ceftobiprole and ceftaroline, currently undergoing clinical evaluation. Besides Enterococci have acquired resistance to many other classes of antibiotics, to which the organisms are not intrinsically resistant, including fluoroquinolones, aminoglycosides, and penicillins. Many strains of E. faecalis are susceptible to certain penicillins, carbapenems, and fluoroquinolones; however, virtually all strains of E. faecium are resistant to these agents [153]. Vancomycin-resistant Enterococci (VRE) infections have bee associated with increased morbidity and mortality [154, 155]. Resistance of Enterococci to vancomycin was reported in Europe in 1986 and the prevalence of infections related to VRE has continued to increase annually [156]. Many factors can increase the risk of colonization with VRE. These include previous antibiotic therapy, the number and duration of antibiotics received, prolonged hospitalization, hospitalization in an intensive care unit and concomitant serious illness [157].