MANAGEMENT OF INFECTIONS CAUSED BY MULTIDRUG-RESISTANT MICROORGANISMS
Abstract
Antimicrobial resistance (AMR) is one of the leading global public health challenges, directly responsible for approximately 1.27 million deaths annually and associated with nearly 4.95 million deaths worldwide. Infections caused by multidrug-resistant (MDR) microorganisms are linked to increased mortality, prolonged hospitalization, higher healthcare costs, and greater therapeutic complexity, particularly in low- and middle-income countries. This integrative literature review aimed to analyze clinical outcomes and recent therapeutic strategies for managing infections caused by MDR bacteria. A PubMed search was conducted in December 2025 using the descriptor “Bacterial Resistance,” prioritizing randomized controlled trials and clinically relevant studies published after 2020. Thirteen studies directly addressing the management of MDR infections were selected. The findings consistently demonstrate that delayed initiation of appropriate antimicrobial therapy is associated with worse clinical outcomes, whereas early targeted treatment reduces mortality, treatment failure, and length of hospital stay. Gram-negative MDR pathogens, particularly Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa, predominate in hospital and intensive care settings. Evidence also supports the use of shorter antimicrobial regimens, which show similar efficacy to prolonged courses while reducing adverse events and selective pressure. Antimicrobial stewardship interventions significantly decrease inappropriate broad-spectrum antibiotic use. Although novel β-lactam combinations and other emerging therapies have expanded treatment options, effective management depends on timely microbiological diagnosis and rational antibiotic use.
Author Biographies
Acadêmico de Radiologia.
Universidade Federal de Minas Gerais.
Acadêmico de Medicina.
Acadêmica de Medicina.
Acadêmica de Medicina.
Ph.D em Demografia pela Johns Hopkins University.
Doutora em Ciências e Técnicas Nucleares.
References
ARNS, B. et al. OPTIMISE Study Group. Seven versus 14 days of antimicrobial therapy for severe multidrug-resistant Gram-negative bacterial infections in intensive care unit patients (OPTIMISE): a randomised, open-label, non-inferiority clinical trial. Critical Care, v. 28, n. 1, art. 412, 2024. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1186/s13054-024-05178-6
BERENDONK, T. U. et al. Tackling antibiotic resistance: the environmental framework. Nature Reviews Microbiology, v. 13, n. 5, p. 310–317, 2015. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1038/nrmicro3439
BOERE, T. M. et al. Effect of point-of-care C-reactive protein testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised trial. BMJ, v. 374, n. 2198, 2021. Acesso em: 03 dez. 2025 DOI: https://doi.org/10.1136/bmj.n2198
BRASIL. Ministério da Saúde. RAM no Brasil. [S. l.]: Ministério da Saúde, s. d. Disponível em: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/r/ram/ram-no-brasil Acesso em: 20 fev 2026.
BRITISH SOCIETY FOR ANTIMICROBIAL CHEMOTHERAPY. Exploration Pub: The role of biofilms in antimicrobial resistance. London: BSAC, 2025.
CLEVINGH, P.; MAILLART, E.; TULKENS, P. M. Response to: “Clinical efficacy and safety of cefiderocol in acute bacterial infections: a systematic review and meta-analysis”. Global Antimicrobial Resistance, v. 26, p. 342–343, 2021. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1016/j.jgar.2021.02.004
CONRADIE, F. et al. Tratamento da tuberculose pulmonar altamente resistente a medicamentos. The New England Journal of Medicine, v. 382, n. 10, p. 893–902, 2020. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1056/NEJMoa1901814
GBD 2021 ANTIMICROBIAL RESISTANCE COLLABORATORS. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet, v. 404, n. 10459, p. 1199-1226, 2024.
GOHIL, S. K. et al. Antimicrobial stewardship improves antibiotic selection for pneumonia: the INSPIRE randomized clinical trial. JAMA, v. 331, n. 23, p. 2007–2017, 2024. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1001/jama.2024.6248
HABBOUSH, Y.; GUZMAN, N. Antibiotic resistance. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK513277/ Acesso em: 03 dez. 2025.
HOLGUÍN, H.; AMARILES, P.; OSPINA, W. Interações evolutivas como possível mecanismo de interações medicamentosas. Revista Chilena de Infectología, v. 34, n. 4, p. 307–313, 2017. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.4067/S0716-10182017000400307
HOLLAND, T. L. et al. Ceftobiprole for complicated Staphylococcus aureus bacteremia. The New England Journal of Medicine, v. 389, n. 15, p. 1390–1401, 2023. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1056/NEJMoa2300220
HSUEH, S.-C. et al. Clinical efficacy and safety of cefiderocol in acute bacterial infections: a systematic review and meta-analysis of randomized clinical trials. Global Antimicrobial Resistance, v. 24, p. 376–382, 2021.
KING, D. T.; SOBHANIFAR, S.; STRYNADKA, N. C. J. One ring to rule them all: current trends in combating bacterial resistance to β-lactams. Protein Science, v. 25, p. 787–803, 2016. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1002/pro.2889
LAMBERT, P. A. Bacterial resistance to antibiotics: modified target sites. Advanced Drug Delivery Reviews, v. 57, n. 10, p. 1471–1485, 2005. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1016/j.addr.2005.04.003
LIU, Miaomiao et al. Potential of marine natural products against drug-resistant bacterial infections. The Lancet Infectious Diseases, v. 19, n. 7, p. e237-e245, 2019. Acesso em: 11 fev. 2026 DOI: https://doi.org/10.1016/S1473-3099(18)30711-4
MACESIC, Nenad; UHLEMANN, Anne-Catrin; PELEG, Anton Y. Multidrug-resistant Gram-negative bacterial infections. The Lancet, v. 405, n. 10474, p. 257-272, 2025.
MINISTÉRIO DA SAÚDE. Plano de Ação Nacional de Prevenção e Controle da Resistência aos Antimicrobianos no Âmbito da Saúde Única 2023-2027 (PAN-BR 2). Brasília, DF: Ministério da Saúde, 2024.
MURRAY, C. J. L. et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, Londres, v. 399, n. 10325, p. 629–655, 2022 DOI: https://doi.org/10.1016/S0140-6736(21)02724-0
O’HARA, B. L.; WONG, S. Alterations in lipopolysaccharide in impermeability-type aminoglycoside resistance in Pseudomonas aeruginosa. Antimicrobial Agents and Chemotherapy, v. 26, n. 2, p. 250–255, 1984. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1128/aac.26.2.250
OJEDA, A. et al. Increased antibiotic resistance in preterm neonates under early antibiotic use. mSphere, v. 9, e00286-24, 2024. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1128/msphere.00286-24
OMBELET, S. et al. Clinical bacteriology in low-resource settings: today’s solutions. The Lancet Infectious Diseases, v. 18, n. 8, p. e248–e258, 2018. Acesso em: 03 dez. 2025 DOI: https://doi.org/10.1016/S1473-3099(18)30093-8
OROMÍ-BOSCH, A.; ANTANI, J. D.; TURNER, P. E. Development of bacteriophage therapy that overcomes bacterial resistance evolution. Annual Review of Virology, v. 10, p. 503–524, 2023. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1146/annurev-virology-012423-110530
PEREZ, Federico; EL CHAKHTOURA, Nadim G.; BONOMO, Robert A. Management of Severe Infections: Multidrug-Resistant and Carbapenem-Resistant Gram-Negative Bacteria. Medical Clinics, v. 109, n. 3, p. 735-747, 2025. Acesso em: 11 fev. 2026 DOI: https://doi.org/10.1016/j.mcna.2025.01.003
PODOLSKY, Scott H. The evolving response to antibiotic resistance (1945–2018). Palgrave Communications, v. 4, n. 1, 2018. Disponível em: https://www.nature.com/articles/s41599-018-0181-x Acesso em: 11 fev. 2026.
POLLOCK, A.; BERGE, E. How to do a systematic review. International Journal of Stroke, v. 13, n. 2, p. 138–156, 2018. Acesso em: 03 dez. 2025 DOI: https://doi.org/10.1177/1747493017743796
SAVADI, P. et al. Nanotechnology-based approaches to tackle bacterial infections. Journal of Controlled Release, v. 387, art. 114204, 2025. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1016/j.jconrel.2025.114204
SCANGARELLA-OMAN, N. E. et al. Efficacy and in vitro activity of gepotidacin against bacterial uropathogens. Antimicrobial Agents and Chemotherapy, v. 69, n. 10, e01639-24, 2025. Acesso em: 02 dez. 2025 DOI: https://doi.org/10.1128/aac.01639-24
SMEDEMARK, S. A. et al. Biomarkers as point-of-care tests to guide prescription of antibiotics in acute respiratory infections. Cochrane Database of Systematic Reviews, v. 10, CD010130, 2022. Acesso em: 03 dez. 2025 DOI: https://doi.org/10.1002/14651858.CD010130.pub3
TISEO, Giusy; GALFO, Valentina; FALCONE, Marco. How I manage patients with New Delhi metallo-beta-lactamase and OXA-48-producing Enterobacterales infections: a practical approach. Current Opinion in Infectious Diseases, v. 38, n. 6, p. 588-597, 2025. Acesso em: 11 fev. 2026 DOI: https://doi.org/10.1097/QCO.0000000000001151
WANG, W. et al. Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis. BMJ Open, v. 8, n. 2, e020991, 2018. Acesso em: 01 dez. 2025 DOI: https://doi.org/10.1136/bmjopen-2017-020991
WORLD HEALTH ORGANIZATION. WHO bacterial priority pathogens list, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: WHO, 2024.
License
Copyright (c) 2026 RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218
This work is licensed under a Creative Commons Attribution 4.0 International License.
Os direitos autorais dos artigos/resenhas/TCCs publicados pertecem à revista RECIMA21, e seguem o padrão Creative Commons (CC BY 4.0), permitindo a cópia ou reprodução, desde que cite a fonte e respeite os direitos dos autores e contenham menção aos mesmos nos créditos. Toda e qualquer obra publicada na revista, seu conteúdo é de responsabilidade dos autores, cabendo a RECIMA21 apenas ser o veículo de divulgação, seguindo os padrões nacionais e internacionais de publicação.