While several drugs now approved treat MRSA, Acinetobacter, Klebsiella pneumoniae Enterobacter aerogenes and their ilk have not yet attracted the pharmaceuticals industry to pursue them. Thanks to this breathing space, they are evolving and becoming even more immune to existing antibiotics.

New York City hospitals have become the global breeding ground for Klebsiella. According to researchers at SUNY Downstate Medical Center, more than 20% of the infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And the supergerms are spread worldwide.

The bacteria can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body US Health authorities do not have good figures on how many infections and deaths in the US are caused by Gram-negative bacteria.

The Centers for Disease Control and Prevention estimates that roughly 1.7m hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted, Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year caused by some of the most troublesome hospital-acquired infections, according to a report released in September by health authorities.

The drug-resistant Gram-negative germs for the most part threaten only hospital patients whose immune systems are weak. The germs can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters and ventilators.

“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, (right) an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, California, and author of “Rising Plague,” on drug-resistant pathogens.

Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. Largely abandoned decades ago because they can cause kidney and nerve damage, these have not been used much, so bacteria have had less chance to evolve resistance to them yet.

Emerging treatment
India's Venus Ltd German based Venus Pharma GmbH, has received marketing authorisation for Meropenem, a Carbapenem injection in European countries through registration in Portugal. Venus Pharma GmbH is a primary centre for European business of Venus in 27 EU countries, EEA members and gulf countries.

Meropenem is indicated for treatment of life threatening infections caused by many gram positive and gram negative bacteria. It is an ultra-broad antibiotic used in treatment of wide variety of infections, including meningitis and pneumonia. It has a market size of about €150m in Europe.

Doribax in the US is another broad-spectrum, intravenous (IV) antibiotic for hospital use, in  a class of antibacterial agents called carbapenems. In clinical studies, it was found to be effective and well-tolerated for the treatment of complicated intra-abdominal infections caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides bulgates, Streptococcus intermedius, Streptococcus constellatus and Peptostreptococcus micros.

“These newly-updated recommendations are intended to guide clinicians treating patients who have, or are at risk for, these serious bacterial infections,” said Susan Nicholson, M.D, Therapeutic Area lead for Anti-Infectives, Ortho-McNeil Janssen Scientific Affairs.“The addition of Doribax as a recommended initial therapy highlights its growing role in treating patients with these infections, particularly Gram-negative infections.”