[Current status and future prospects of antibacterial treatment for Carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients].

Q3 Medicine
C R Ju, X Xu, X Xu, W J Xue
{"title":"[Current status and future prospects of antibacterial treatment for Carbapenem-resistant gram-negative bacterial infections in solid organ transplant recipients].","authors":"C R Ju, X Xu, X Xu, W J Xue","doi":"10.3760/cma.j.cn112137-20250218-00381","DOIUrl":null,"url":null,"abstract":"<p><p>In recent years, infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) and other multidrug-resistant (MDR) pathogens have posed significant challenges in solid organ transplantation (SOT). SOT recipients who develop CR-GNB infections face risks such as graft loss, respiratory failure, leading to a mortality rate exceeding 40%. This review examines the current resistance landscape and the characteristics of MDR infections in SOT recipients, discussing the epidemiological features of CR-GNB infections in SOT patients, the resistance profiles and mechanisms of common CR-GNB (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa), and evidence-based principles and strategies for antimicrobial therapy. The article provides an in-depth analysis of the efficacy, pharmacokinetic/pharmacodynamic (PK/PD) properties, and adverse effects of both commonly used antibiotics (such as tigecycline, polymyxins, and ceftazidime/avibactam) and the novel agents (including eravacycline and sulbactam/durlobactam), emphasizing the importance of combination therapy and personalized treatment approaches. Additionally, it explores the clinical potential of emerging rapid diagnostic technologies (e.g., CRISPR/Cas systems, mass spectrometry) and innovative treatments such as phage therapy and immunomodulation. Looking ahead, the review envisions a future where, guided by rapid and precise diagnostics, multidisciplinary management can optimize antimicrobial regimens for MDR infections in transplant recipients. The goal is to achieve individualized, effective treatment strategies, thereby improving outcomes in severe infections and advancing the management of CR-GNB infections in SOT patients in China.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2701-2708"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zhonghua yi xue za zhi","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3760/cma.j.cn112137-20250218-00381","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

In recent years, infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) and other multidrug-resistant (MDR) pathogens have posed significant challenges in solid organ transplantation (SOT). SOT recipients who develop CR-GNB infections face risks such as graft loss, respiratory failure, leading to a mortality rate exceeding 40%. This review examines the current resistance landscape and the characteristics of MDR infections in SOT recipients, discussing the epidemiological features of CR-GNB infections in SOT patients, the resistance profiles and mechanisms of common CR-GNB (e.g., Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa), and evidence-based principles and strategies for antimicrobial therapy. The article provides an in-depth analysis of the efficacy, pharmacokinetic/pharmacodynamic (PK/PD) properties, and adverse effects of both commonly used antibiotics (such as tigecycline, polymyxins, and ceftazidime/avibactam) and the novel agents (including eravacycline and sulbactam/durlobactam), emphasizing the importance of combination therapy and personalized treatment approaches. Additionally, it explores the clinical potential of emerging rapid diagnostic technologies (e.g., CRISPR/Cas systems, mass spectrometry) and innovative treatments such as phage therapy and immunomodulation. Looking ahead, the review envisions a future where, guided by rapid and precise diagnostics, multidisciplinary management can optimize antimicrobial regimens for MDR infections in transplant recipients. The goal is to achieve individualized, effective treatment strategies, thereby improving outcomes in severe infections and advancing the management of CR-GNB infections in SOT patients in China.

[实体器官移植受者耐碳青霉烯革兰氏阴性菌感染的抗菌治疗现状及未来展望]。
近年来,碳青霉烯耐药革兰氏阴性菌(CR-GNB)和其他多药耐药(MDR)病原体引起的感染对实体器官移植(SOT)提出了重大挑战。发生CR-GNB感染的SOT受者面临移植物丢失、呼吸衰竭等风险,导致死亡率超过40%。本文综述了目前SOT受者耐多药感染的耐药情况和特点,讨论了SOT患者CR-GNB感染的流行病学特征,常见CR-GNB(如肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌)的耐药概况和机制,以及基于证据的抗菌治疗原则和策略。本文深入分析了常用抗生素(如替加环素、多粘菌素、头孢他啶/阿维巴坦)和新型抗生素(如依瓦环素、舒巴坦/杜罗巴坦)的疗效、药代动力学/药效学(PK/PD)特性和不良反应,强调了联合治疗和个性化治疗的重要性。此外,它还探讨了新兴快速诊断技术(如CRISPR/Cas系统,质谱)和创新治疗方法(如噬菌体治疗和免疫调节)的临床潜力。展望未来,该综述展望了在快速和精确诊断的指导下,多学科管理可以优化移植受者耐多药感染的抗菌方案。目标是实现个体化、有效的治疗策略,从而改善中国SOT患者严重感染的结局,并推进CR-GNB感染的管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Zhonghua yi xue za zhi
Zhonghua yi xue za zhi Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
400
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信