Gram-negative bloodstream infections.

Gram-negative bloodstream infection (BSI) is both dangerous and challenging. The incidence of Gram-negative BSI rises with age in both men and women, but there are still some gender differences in terms of aetiology and acquisition. Clinical elements such as organ dysfunction are helpful in determining prognosis. During the last few years we have observed dramatic increases in resistance among Gram-negative organisms, including those causing bloodstream infections. Gram-negative pathogens producing extended-spectrum beta-lactamases are now common, and are associated with high rates of inadequate empirical treatment and mortality. In addition, carbapenem resistance is increasing, leaving clinicians with limited therapeutic options. Better knowledge of local epidemiology can help to optimize therapies. The use of cefepime has been questioned based on a recent meta-analysis showing increased mortality in patients treated with the drug. However, an analysis performed by the US Food and Drug Administration has not confirmed these results. Unfortunately, antimicrobial development has not kept pace with resistance, particularly for Gram-negative pathogens. We need therefore to better utilize current antibiotics and undertake rigorous infection control measures to prevent these life-threatening infections.