Helfand Marion S, Bonomo Robert A
Infectious Diseases Section, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA.
Curr Opin Pharmacol. 2005 Oct;5(5):452-8. doi: 10.1016/j.coph.2005.04.013.
Gram-negative bacteria that produce extended-spectrum- and metallo-beta-lactamases are being discovered at an alarming rate, while the development of new antimicrobial agents has almost ground to a standstill. A body of experience exists with the detection and treatment of extended-spectrum beta-lactamase-producing organisms (Klebsiella pneumoniae and Escherichia coli), suggesting that knowledge of their existence and dissemination might have an impact on therapeutic choices and patient outcomes via targeted empirical antimicrobial selection and infection control practices. It is unclear whether the same mandate exists for the detection of metallo-beta-lactamases. As dictated by local susceptibility patterns, in many settings worldwide empirical therapy in serious nosocomial infections now requires the use of carbapenems alone or in combination with a second antibiotic that is also effective against Gram-negative pathogens; colistin is advocated as the empirical drug of choice in the setting of multidrug-resistant Pseudomonas aeruginosa infections, although high doses of beta-lactams might prove to be effective.
产超广谱β-内酰胺酶和金属β-内酰胺酶的革兰氏阴性菌正以惊人的速度被发现，而新型抗菌药物的研发几乎陷入停滞。在检测和治疗产超广谱β-内酰胺酶的生物体（肺炎克雷伯菌和大肠杆菌）方面已有一定经验，这表明了解它们的存在和传播情况可能会通过有针对性的经验性抗菌药物选择和感染控制措施，对治疗选择和患者预后产生影响。目前尚不清楚检测金属β-内酰胺酶是否也有同样的要求。根据当地的药敏模式，在全球许多地方，严重医院感染的经验性治疗现在需要单独使用碳青霉烯类药物或与另一种对革兰氏阴性病原体也有效的抗生素联合使用；对于多重耐药铜绿假单胞菌感染，虽然高剂量的β-内酰胺类药物可能有效，但多粘菌素被推荐作为经验性首选药物。
