MDR/XDR/PDR还是DTR?哪种定义最符合铜绿假单胞菌的耐药性?

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2023-12-01 Epub Date: 2023-09-26 DOI:10.1097/QCO.0000000000000966
Federica Cosentino, Pierluigi Viale, Maddalena Giannella
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引用次数: 0

摘要

综述目的:本叙述性综述的目的是比较难治耐药性(DTR)的新定义与已建立的定义在铜绿假单胞菌感染患者中的预后效用,以了解耐药性分类的治疗意义及其对临床结果的影响。最近的发现:在革兰氏阴性菌(GNB)中,铜绿假单胞菌(PA)的发病率和死亡率较高,主要与其产生抗生素耐药性的内在能力有关。在过去的15年中,已经提出了几种抗生素耐药性的分类 年。最常用的是来自Magiorakos等人的药物。根据显示体外活性的抗生素类别的数量,包括多药耐药性(MDR)、广泛耐药(XDR)和泛耐药(PDR)。还提出了基于对特定抗生素类别(即氟喹诺酮类、头孢菌素类、碳青霉烯类耐药性)的耐药性的进一步分类。然而,这两种方法都受到了批评,因为它们在临床实践中的作用有限,并且与患者结果的相关性较差,主要是在PA引起的感染中。最近提出了新的难治耐药性(DTR)定义,指的是对所有表现出高效低毒的一线药物(即碳青霉烯类、β-内酰胺-β-内酶抑制剂组合和氟喹诺酮类)不敏感。包括大量GNB血流感染患者的研究已经证实了DTR分类的预后价值及其主要在PA感染中的临床实用性。事实上,在美国传染病学会(IDSA)最近关于抗生素耐药性GNB感染管理的文件中,DTR分类应用于PA。总结:DTR定义似乎比MDR/XDR/PDR和单级耐药类别更能识别治疗选择有限的PA病例。它需要定期修订,以跟上新抗生素的引入和耐药性的演变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
MDR/XDR/PDR or DTR? Which definition best fits the resistance profile of Pseudomonas aeruginosa?

Purpose of review: The aim of this narrative review is to compare the prognostic utility of the new definition of difficult-to-treat resistance (DTR) vs. established definitions in patients with Pseudomonas aeruginosa infection to understand the therapeutic implications of resistance classification and its impact on clinical outcome.

Recent findings: Among Gram-negative bacteria (GNB), P. aeruginosa (PA) is associated with high rates of morbidity and mortality, mostly related to its intrinsic capacity of developing antibiotic resistance. Several classifications of antibiotic resistance have been proposed in the last 15 years. The most common used is that from Magiorakos et al. including multidrug resistance (MDR), extensively drug-resistant (XDR) and pan drug resistance (PDR) according to the number of antibiotic classes showing in vitro activity. A further classification based on the resistance to specific antibiotic classes (i.e. fluoroquinolones, cephalosporins, carbapenem resistance) was also proposed. However, both of them have been criticized because of limited usefulness in clinical practice and for poor correlation with patient outcome, mainly in infections due to PA. More recently the new definition of difficult-to-treat resistance (DTR) has been proposed referring to nonsusceptibility to all first-line agents showing high-efficacy and low-toxicity (i.e. carbapenems, β-lactam-β-lactamase inhibitor combinations, and fluoroquinolones). Studies including large cohorts of patients with GNB bloodstream infections have confirmed the prognostic value of DTR classification and its clinical usefulness mainly in infections due to PA. Indeed, in the recent documents from the Infectious Diseases Society of America (IDSA) on the management of antibiotic resistant GNB infections, the DTR classification was applied to PA.

Summary: DTR definition seems to identify better than MDR/XDR/PDR and single class resistant categories the cases of PA with limited treatment options. It requires periodic revision in order to remain up-to-date with the introduction of new antibiotics and the evolving pattern of resistance.

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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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