Arias Cesar A, Murray Barbara E
Center for the Study of Emerging and Re-Emerging Pathogens, Division of Infectious Diseases, and Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA.
Expert Rev Anti Infect Ther. 2008 Oct;6(5):637-55. doi: 10.1586/14787210.6.5.637.
The treatment of multidrug-resistant enterococcal infections continues to be a challenge for clinicians. Glycopeptide and beta-lactam resistance is now a common feature of the majority of Enterococcus faecium hospital isolates, and resistance to aminoglycosides, quinupristin-dalfopristin, linezolid and daptomycin further complicates the problem. New antibiotics, such as tigecycline, lipoglycopeptides (dalbavancin, oritavancin and telavancin) and cephalosporins with activity against Enterococcus faecalis (ceftobiprole and ceftaroline), may have potential activity against certain resistant enterococcal strains in specific clinical settings, as may some older antibiotics, such as ampicillin, chloramphenicol, doxycycline, minocycline and nitrofurantoin. However, the treatment of endovascular infections (particularly endocarditis, where bactericidal therapy is important for optimal cure rates) caused by resistant enterococci continues to be an immense challenge even with the availability of new agents. The optimal therapy for these infections is not well established and clinical data are usually limited to case reports with conflicting results. Therefore, treatment decisions may have to be based on animal models and sporadic experiences and the best approach is for the physician to consider carefully each patient on a case by case manner and gather all the clinical and microbiological information possible regarding species identification and susceptibilities in order to choose a therapeutic regimen that would appear to be active.
对临床医生来说，耐多药肠球菌感染的治疗仍然是一项挑战。糖肽类和β-内酰胺类耐药现在是大多数医院分离的屎肠球菌的共同特征，对氨基糖苷类、奎奴普丁-达福普汀、利奈唑胺和达托霉素的耐药进一步使问题复杂化。新抗生素，如替加环素、脂糖肽类（达巴万星、奥利万星和特拉万星）以及对粪肠球菌有活性的头孢菌素（头孢比普和头孢洛林），在特定临床环境中可能对某些耐药肠球菌菌株具有潜在活性，一些较老的抗生素，如氨苄西林、氯霉素、多西环素、米诺环素和呋喃妥因也可能如此。然而，即使有新药物可用，由耐药肠球菌引起的血管内感染（特别是心内膜炎，杀菌治疗对最佳治愈率很重要）的治疗仍然是一项巨大挑战。这些感染的最佳治疗方法尚未明确确立，临床数据通常仅限于结果相互矛盾的病例报告。因此，治疗决策可能不得不基于动物模型和零星经验，最佳方法是医生逐案仔细考虑每个患者，并收集所有可能的临床和微生物学信息，包括菌种鉴定和药敏情况，以便选择一种似乎有效的治疗方案。
