The past two decades have witnessed the emergence of a heterogeneous group of facultative,
Gram-negative pathogens that are resistant to one or more classes of conventional
parenteral antibiotics. Antibiotic-resistant Gram-negative bacteria primarily affect
critically ill, hospitalized patients, particularly those in large tertiary care centers.
The genera most frequently associated are those included in the family Enterobacteriaceae,
most commonly Enterobacter, Klebsiella, Citrobacter, and Serratia, as well as nonenteric, nonfermenting bacteria such as Pseudomonas and Acinetobacter. The antibiotic susceptibility patterns of resistant bacilli have evolved over the
years, reflecting the antimicrobial regimens in widest use at the time. Resistance
was originally confined to kanamycin and gentamicin, then extended to all of the aminoglycosides,
including amikacin, then to both the older and more recently developed extended spectrum
β-lactam agents, including the advanced-generation cephalosporins and penicillins.
Although most Gram-negative bacilli currently remain susceptible to the carbapenems
and the fluoroquinolones, resistance to these agents has also been described.
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