Unmet Medical Need in
(MDR) infections are rapidly increasing
worldwide, and, unfortunately, few new
antimicrobials capable of treating these
infections are under development [1, 2].
The emergence of infections for which
there are limited treatment options rep-
resents a critical unmet medical need. In
October 2011, we electronically surveyed
the 1356 members of the Emerging In-
fections Network (EIN) about 3 areas of
unmet medical need in the treatment of
Respondents ranked the severity of
unmet medical need for different infec-
tions from 1 (least severe) to 5 (most
severe). Respondents also ranked the
importance of specific challenges related
to the treatment of MDR infections
from 1 (not important) to 5 (most impor-
tant). Finally, they ranked 5 specific
strategies designed to combat antibiotic-
resistant infections in the order in which
they felt would best aid in targeting these
infections. Additional questions perta-
ined to use of polymyxin B/E (colistin).
We received 562 responses (41.6%).
The severity of unmet medical need was
viewed as greatest for MDR gram-nega-
tive bacilli (mean score, 4.6), higher
than for methicillin-resistant Staphylo-
coccus aureus (MRSA), MDR tuberculo-
sis, aspergillosis, and MDR gonorrhea
(Figure 1A). The greatest challenge in
the treatment of MDR infections was
noted to be the limited number of new
(mean score, 4.7) (Figure 1B). Respon-
dents believed that the development of
new antibacterials (mean score, 3.4) and
more aggressive antimicrobial steward-
ship programs were the most important
strategies in combating MDR infections
(Figure 1C). Sixty-four percent of re-
spondents reported using colistin during
the previous year, 63% reported caring
for a patient with an infection resistant
to all available antibacterials, and 56%
believe that the number of these untrea-
table infections is increasing.
We found that management of infec-
tion due to MDR gram-negative bacteria
medical need in infectious diseases. In
their practice, EIN members are experi-
encing an alarming increase in infec-
tions due to MDR gram-negative bacilli
for which few and, in some cases, no ef-
fective therapies exist. In response, the
Infectious Diseases Society of America
has taken an active role in supporting
control of antibiotic resistance and in-
centives for new drug development (the
Generating Antibiotic Incentives Now
Act).  Although MRSA and tubercu-
losis have drawn the attention of the
public media, infectious diseases clini-
cians from the EIN believed that gram-
negative bacilli represent a far greater
unmet need. From the vantage of front-
line physicians, the limited number of
new antibacterials represents both the
greatest limitation and the most impor-
tant solution to combating this crisis.
ported by the National Institutes of Health and
the Centers for Disease Control and Prevention
(grants to P. M. P.).
Potential conflicts of interest.
No reported conflicts.
All authors have submitted the ICMJE Form
for Disclosure of Potential Conflicts of Interest.
Conflicts that the editors consider relevant to
the content of the manuscript have been
This work was sup-
Adam L. Hersh,1Jason G. Newland,2Susan
E. Beekmann,3Philip M. Polgreen,3and
David N. Gilbert4
1Pediatric Infectious Diseases, Department of
Pediatrics, University of Utah, Salt Lake City;
2Pediatric Infectious Diseases, Children’s Mercy
Hospital and Clinics, Kansas City, Missouri;
3Department of Internal Medicine, Carver College of
Medicine, University of Iowa, Iowa City; and
4Infectious Diseases and Earle A. Chiles Research
Institute, Providence Portland Medical Center and
Oregon Health and Sciences University
1. Boucher HW, Talbot GH, Bradley JS, et al.
Bad bugs, no drugs: no ESKAPE! An update
from the Infectious Diseases Society of
America. Clin Infect Dis 2009; 48:1–12.
2. The Center for Disease Dynamics, Economics
and Policy. Resistance Map Available at: http
://www.cddep.org/resistancemap. Accessed 28
(IDSA). Spellberg B, Blaser M, Guidos RJ,
et al. Combating antimicrobial resistance:
policy recommendations to save lives. Clin
Infect Dis 2011; 52(Suppl 5):S397–428.
Correspondence: Adam L. Hersh, MD, PhD, 295 Chipeta Way,
Salt Lake City, UT 84108 (firstname.lastname@example.org).
Clinical Infectious Diseases
© The Author 2012. Published by Oxford University Press on
behalf of the Infectious Diseases Society of America. All
rights reserved. For Permissions, please e-mail: journals.
CORRESPONDENCE • CID 2012:54 (1 June) • 1677
Figure 1. Download full-text
importance of challenges in the treatment of multidrug-resistant infections, ranging from 1 (least important) to 5 (most important). C, Mean score for
rating importance of various strategies in combating antibiotic-resistant infections, ranging from 1 (least important) to 5 (most important). Abbreviations:
MDR, multidrug-resistant; MRSA, methicillin-resistant Staphylococcus aureus; TB, tuberculosis.
A, Mean score for rating severity of unmet medical need, ranging from 1 (least severe) to 5 (most severe). B, Mean score for rating
1678 • CID 2012:54 (1 June) • CORRESPONDENCE