期刊
CLINICAL MICROBIOLOGY REVIEWS
卷 31, 期 2, 页码 -出版社
AMER SOC MICROBIOLOGY
DOI: 10.1128/CMR.00079-17
关键词
multidrug resistance; antimicrobial therapy; extended-spectrum beta-lactamases; carbapenemases; bloodstream infections; mortality
类别
资金
- Plan Nacional de I+D+i
- Instituto de Salud Carlos III
- Subdireccion General de Redes y Centros de Investigacion Cooperativa
- Ministerio de Economia y Competitividad
- Spanish Network for Research in Infectious Diseases [RD16/0016/0001, RD16/0016/0008]
- European Development Regional Fund A Way to Achieve Europe
- Operational Program for Smart Growth
- Innovative Medicines Initiative (IMI)
- European Union's Seventh Framework Programme
Therapy of invasive infections due to multidrug-resistant Enterobacteriaceae (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum beta-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer beta-lactam-beta-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing Enterobacteriaceae (CPE), only some second-line drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.
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