严重铜绿假单胞菌感染的管理策略。

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2023-12-01 Epub Date: 2023-10-12 DOI:10.1097/QCO.0000000000000981
Hermann Do Rego, Jean-François Timsit
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引用次数: 0

摘要

目的:本文综述危重患者严重铜绿假单胞菌感染的处理。最新发现:铜绿假单胞菌是重症监护中最常见的病原体;主要的相关感染是医院内肺炎,然后是血液感染。抗微生物耐药性很常见;尽管有新的抗生素,但它与死亡率增加有关,并可能导致治疗僵局。摘要:难治铜绿假单胞菌(DTR-PA)对碳青霉烯的耐药性主要由OprD通道蛋白的缺失或减少、头孢菌素酶AmpC的过度表达和/或外排泵的过度表达介导。然而,碳青霉烯酶,特别是金属-β-内酰胺酶的作用变得更加重要。头孢他唑烷-他唑巴坦、头孢他啶-阿维巴坦和亚胺培南-雷巴坦对DTR表型(非碳青霉烯酶产生者)有用。其他新制剂,如氨曲南-头孢他啶-阿维巴坦、头孢地罗醇或粘菌素,可能对碳青霉烯酶生产商有效。关于非抗生素,可能只考虑噬菌体,等待进一步的临床试验。联合治疗不能降低死亡率,但对于经验治疗来说可能是必要的。当预计临床情况会迅速好转时,应首选短期治疗严重的铜绿假单胞菌感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management strategies for severe Pseudomonas aeruginosa infections.

Purpose of review: This review focuses on the management of severe Pseudomonas aeruginosa infections in critically ill patients.

Recent findings: Pseudomonas aeruginosa is the most common pathogen in intensive care; the main related infections are nosocomial pneumonias, then bloodstream infections. Antimicrobial resistance is common; despite new antibiotics, it is associated with increased mortality, and can lead to a therapeutic deadlock.

Summary: Carbapenem resistance in difficult-to-treat P. aeruginosa (DTR-PA) strains is primarily mediated by loss or reduction of the OprD porin, overexpression of the cephalosporinase AmpC, and/or overexpression of efflux pumps. However, the role of carbapenemases, particularly metallo-β-lactamases, has become more important. Ceftolozane-tazobactam, ceftazidime-avibactam and imipenem-relebactam are useful against DTR phenotypes (noncarbapenemase producers). Other new agents, such as aztreonam-ceftazidime-avibactam or cefiderocol, or colistin, might be effective for carbapenemase producers. Regarding nonantibiotic agents, only phages might be considered, pending further clinical trials. Combination therapy does not reduce mortality, but may be necessary for empirical treatment. Short-term treatment of severe P. aeruginosa infections should be preferred when it is expected that the clinical situation resolves rapidly.

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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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