aDepartment of Medicine, Mount Sinai School of Medicine, New York, New York, USA bResearch Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, USA cDivision of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, USA dDepartment of Medicine, Case Western Reserve School of Medicine, USA eDepartment of Molecular Biology and Microbiology, Case Western Reserve School of Medicine, USA fDepartment of Pharmacology, Case Western Reserve School of Medicine, Cleveland, Ohio, USA.
Curr Opin Organ Transplant. 2010 Dec;15(6):676-82. doi: 10.1097/MOT.0b013e3283404373.
This review highlights the impact of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii on patients who have undergone organ transplantation and explores both available and potential agents to treat infections caused by these multidrug-resistant (MDR) pathogens.
Few antimicrobials exist to treat carbapenem-resistant Gram-negative infections, and resistance to salvage therapies is escalating. Organ transplantation appears to be a risk factor for infections with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae. Isolation of these MDR bacteria is increasing and may be associated with allograft failure and mortality. In the majority of cases, aminoglycosides, polymyxins, and tigecycline have been employed to treat these infections. Anecdotal successes exist but these antibiotics may be unreliable. Few novel agents are in development.
Bacterial infections remain a leading cause of posttransplantation morbidity and mortality. Carbapenem resistance is a significant threat to allograft and patient survival. With few antimicrobials being developed, transplant centers may be forced to make decisions regarding surveillance, empiric antimicrobial regimens, and transplant candidacy in the setting of carriage of MDR pathogens. There is an urgent need for collaborative studies to address the clinical impact of these infections on transplantation.
本文重点阐述了耐碳青霉烯类肠杆菌科（Carbapenem-resistant Enterobacteriaceae，CRE）和耐碳青霉烯类鲍曼不动杆菌（Carbapenem-resistant Acinetobacter baumannii，CRAB）对接受器官移植患者的影响，并探讨了治疗这些多重耐药（Multidrug-resistant，MDR）病原体感染的现有和潜在药物。
目前治疗耐碳青霉烯类革兰氏阴性菌感染的抗菌药物有限，且针对挽救性治疗的耐药性正在不断上升。器官移植似乎是产碳青霉烯酶肠杆菌科细菌感染的一个危险因素。这些 MDR 细菌的分离率正在上升，可能与同种异体移植物失功和死亡有关。在大多数情况下，氨基糖苷类、多黏菌素类和替加环素被用于治疗这些感染。虽然有一些成功的案例，但这些抗生素可能并不可靠。目前仅有少数新型药物正在开发中。
细菌感染仍然是移植后发病率和死亡率的主要原因。碳青霉烯类耐药性对同种异体移植物和患者的生存构成了重大威胁。由于新抗菌药物的开发有限，移植中心可能不得不根据携带 MDR 病原体的情况下进行监测、经验性抗菌治疗方案以及移植候选者的决策。迫切需要开展合作研究，以解决这些感染对移植的临床影响。
