**7. Conclusion**

Carbapenem-resistant Gram-negative bacilli are one of the leading causes of nosocomial pneumonia. They are particularly involved in the outbreaks in ICUs. These strains are very often multidrug resistant, putting additional pressure on physicians and clinical microbiologists. Bacteriological diagnosis provides essential evidence for carbapenem-resistant Gram-negative bacillary pneumonia. From the very beginning, the Gram smear from respiratory specimens shows to be indispensable for an accurate diagnosis. Preventing respiratory infections in ICUs is a challenging issue; antibiotic prescription for any kind of acute respiratory tract infection does not benefit the patients. Besides, carbapenem-resistant bacilli already exist not only in clinical units but also alter environmental microbiota. It is time for a different approach in dealing with the antibiotic-resistance issues. An endless struggle with microorganisms does not work; these tiny creatures have incredible resources to deal with any new chemotherapeutic agent. We do not have the slightest idea of the long-term impact of widespread antibiotic use on environmental microorganisms. Careful analysis of existing data, like the evidence deposited in public databases, and reconsidering the antibacterial efficiency of natural products, such as EOs, could help at dealing with multidrug-resistant organisms.

**References**

[1] Sutherasan Y, Peñuelas O, Muriel A, Vargas M, Frutos-Vivar F, Brunetti I, et al. Management and outcome of mechanically ventilated patients after cardiac arrest.

The Emerging Problems of Carbapenem-Resistant Gram-Negative Bacillary Pneumonia

http://dx.doi.org/10.5772/intechopen.69630

71

[2] Suwantarat N, Carroll KC. Epidemiology and molecular characterization of multidrug-resistant gram-negative bacteria in Southeast Asia. Antimicrobila Resistance and

[3] Le NK, Hf W, Vu PD, Khu DTK, Le HT, Hoang BTN, et al. High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey. Medicine (Baltimore).

[4] Tamma PD, Han JH, Rock C, Harris AD, Lautenbach E, Hsu AJ, et al. Carbapenem therapy is associated with improved survival compared with piperacillin-tazobactam for patients with extended-spectrum β-lactamase bacteremia. Clinical Infectious Diseases.

[5] Shapira S, Pleban S, Kazanov D, Tirosh P, Arber N. Terpinen-4-ol: A novel and promising therapeutic agent for human gastrointestinal cancers. PLoS One. 2016;**11**:e0156540.

[6] Arweiler NB, Donos N, Netuschil L, Reich E, Sculean A. Clinical and antibacterial effect

[7] Biak-Bielinska A, Kumirska J, Stepnowski P. What do we know about the chronic and mixture toxicity of the residues of sulfonamides in the environment? Organic Pollutants—Monitoring Risk and Treatment. InTech, Croatia; 2013. DOI: 10.5772/53732

[8] Ory J, Bricheux G, Togola A, Bonnet JL, Donnadieu-Bernard F, Nakusi L, et al. Ciprofloxacin residue and antibiotic-resistant biofilm bacteria in hospital effluent.

[9] Munsch-Alatossava P, Ikonen V, Alatossava T, Gauchi J-P. Trends of antibiotic resistance (AR) in mesophilic and psychrotrophic bacterial populations during cold storage of raw milk, produced by organic and conventional farming systems. Antibiotic Resistance Bacteria—A Continuous Challenge New Millennium, InTech, Croatia; 2012.

[10] Woese CR. There must be a prokaryote somewhere: Microbiology's search for itself.

[11] Silva TP, Gamalier JP, Melo RCN. TEM as an important tool to study aquatic microorganisms and their relationships with ecological processes. Modern Electron Microscopy

Microbiological Reviews. 1994;**58**:1-9. DOI: 10146-0749/94/\$04.00+0

in Physical and Life Sciences. InTech, Croatia; 2016. DOI: 10.5772/61804

Environmental Pollution. 2016;**214**:635-645. DOI: 10.1016/j.envpol.2016.04.033

of tea tree oil—A pilot study. Clinical Oral Investigation. 2000;**4**:70-73

Critical Care. 2015;**19**:215. DOI: 10.1186/s13054-015-0922-9

Infection Control. 2016;**5**:15. DOI: 10.1186/s13756-016-0115-6

2016;**95**:e4099. DOI: 10.1097/MD.0000000000004099

2015;**60**:1319-1325. DOI: 10.1093/cid/civ003

DOI: 10.1371/journal.pone.0156540

DOI: 10.5772/29994
