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Gram-positive bacteria 

Gram-positive bacteria
Chapter:
Gram-positive bacteria
DOI:
10.1093/med/9780198729228.003.0027
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date: 18 November 2019

A very large number of Gram-negative bacteria are potential human pathogens; these include Enterobacteriaceae and a range of biochemically less active (non-fermentative) bacteria such as Pseudomonas species. Enterobacteriaceae include species that are ubiquitous human commensals and opportunistic pathogens (e.g. Escherichia coli); other species that are less common commensals but important opportunistic pathogens (e.g. Enterobacter); and species, such as Salmonella and Shigella, that are unequivocal pathogens. Pseudomonas aeruginosa is the most important non-fermentative Gram-negative bacteria. Infections with these bacteria may be endogenous or exogenous. Common and/or important infections caused by these bacteria include urinary tract infections, gastrointestinal tract infections, bloodstream infections, and meningitis. Neonates are at especially high risk of serious invasive infections with these bacteria. Diagnosis is mainly by microscopy and culture of material collected from the site of infection. Antibiotic treatment of infections with these bacteria is becoming more challenging. Enterobacteriaceae that are resistant to several antibiotic classes (penicillins, cephalosporins, aminoglycosides, fluoroquinolones) are becomingly increasingly prevalent both in hospitals and in the community. Until recently, carbapenems have been the mainstay of treatment of infections with these bacteria, but carbapenemase-producing Gram-negative bacteria are becoming increasingly common. Non-fermentative Gram-negative bacteria are often intrinsically resistant to many commonly used antibiotics, and acquired resistance is also becoming increasingly common. There are only a limited number of new antibiotics on the horizon to treat infections with these bacteria. Infection control of multidrug-resistant Gram-negative bacteria is therefore very important. Many hospitals now screen for asymptomatic carriers in high-risk areas, but the effectiveness of this approach is uncertain.

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