Management of MDR/XDR severe infections in the critically ill.

IF 3.4 3区医学 Q1 CRITICAL CARE MEDICINE

Current Opinion in Critical Care Pub Date : 2025-10-01 Epub Date: 2025-08-11 DOI:10.1097/MCC.0000000000001307

Luca Mezzadri, Ya-Ting Chang, David L Paterson

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引用次数: 0

Abstract

Purpose of review: This review aims to summarize current recommendations for the management of serious infections, such as bloodstream infections (BSIs) and ventilator-associated pneumonia, caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, focusing on evidence from randomized controlled trials (RCTs) and emerging treatment options.

Recent findings: Vancomycin, linezolid, and daptomycin represent the main therapeutic options for the management of methicillin-resistant Staphylococcus aureus infections; among newer agents, ceftobiprole has recently gained approval for BSI treatment. For vancomycin-resistant Enterococcus faecium BSIs, linezolid and daptomycin remain commonly employed despite the lack of comparative RCTs guiding treatment decisions. The management of MDR/XDR Gram-negative infections is challenging, owing to sparse clinical trials for robust guidance and rapid emergence of diverse resistance mechanisms. New beta-lactam/beta-lactamase inhibitor combinations remain the cornerstone of treatment for carbapenem-resistant Enterobacterales and carbapenem-resistant Pseudomonas aeruginosa. Cefiderocol and the combination of ceftazidime-avibactam plus aztreonam represent the current last-resort options for metallo-β-lactamase producers. For carbapenem-resistant Acinetobacter baumannii, sulbactam-durlobactam has demonstrated at least comparable activity compared to colistin but is unavailable in most countries.

Summary: Optimal management of serious infections by MDR/XDR pathogens requires up-to-date knowledge of evolving treatment options and resistance mechanisms. Further high-quality clinical trials are needed to guide evidence-based therapy.

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对危重病人中耐多药/广泛耐药严重感染的管理。

综述目的：本综述旨在总结目前关于由多药耐药（MDR）和广泛耐药（XDR）病原体引起的严重感染（如血流感染（bsi）和呼吸机相关肺炎）管理的建议，重点关注随机对照试验（rct）的证据和新兴的治疗方案。最新发现：万古霉素、利奈唑胺和达托霉素是耐甲氧西林金黄色葡萄球菌感染的主要治疗选择；在较新的药物中，ceftobiprole最近被批准用于BSI治疗。对于耐万古霉素的屎肠球菌bsi，尽管缺乏指导治疗决策的比较随机对照试验，但利奈唑胺和达托霉素仍然被普遍使用。耐多药/广泛耐药革兰氏阴性感染的管理是具有挑战性的，因为缺乏强有力指导的临床试验，而且多种耐药机制迅速出现。新的β -内酰胺/ β -内酰胺酶抑制剂组合仍然是耐碳青霉烯肠杆菌和耐碳青霉烯铜绿假单胞菌治疗的基石。头孢地罗和头孢他啶-阿维巴坦加阿曲南的组合是目前金属β-内酰胺酶生产商的最后选择。对于耐碳青霉烯鲍曼不动杆菌，舒巴坦-杜罗巴坦已证明至少与粘菌素具有相当的活性，但在大多数国家无法获得。摘要：对耐多药/广泛耐药病原体严重感染的最佳管理需要对不断发展的治疗方案和耐药机制有最新的了解。需要进一步的高质量临床试验来指导循证治疗。

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来源期刊

Current Opinion in Critical Care 医学-危重病医学

CiteScore

5.90

自引率

3.00%

发文量

172

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.