Chan-Tompkins Noreen H
Department of Pharmacy, Allegheny General Hospital, 320 E. North Ave., Pittsburgh, PA 15212, USA.
Crit Care Nurs Q. 2011 Apr-Jun;34(2):87-100. doi: 10.1097/CNQ.0b013e31820f6e88.
Multidrug-resistant (MDR) gram-negative infections have become challenging to treat when there is only a limited armamentarium of anti-infectives that are commercially available. In particular, increasing resistance of gram-negative organisms such as Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacter species have become concerning. Carbapenems have been used to treat extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species infections. However, because of carbapenemase-producing K pneumoniae strains, other MDR gram-negative infection treatment options are limited to antibiotics with in vitro spectrum of activity against these MDR pathogens and may include the use of tigecycline, polymyxin B, or polymxyin E (colistin). Because of the potential for nephrotoxicity or neurotoxicity with the polymyxins, clinicians should be vigilant in preventing its adverse effects. Clinicians are encouraged to support the Infectious Diseases Society of America's 10 × '20 Initiative in gaining global commitment to develop additional antimicrobials for the future.
当市面上可用的抗感染药物种类有限时，耐多药（MDR）革兰氏阴性菌感染的治疗变得具有挑战性。特别是，肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌属等革兰氏阴性菌的耐药性不断增加，令人担忧。碳青霉烯类药物已被用于治疗产超广谱β-内酰胺酶（ESBL）的大肠杆菌和克雷伯菌属感染。然而，由于产碳青霉烯酶的肺炎克雷伯菌菌株的出现，其他耐多药革兰氏阴性菌感染的治疗选择仅限于对这些耐多药病原体具有体外活性谱的抗生素，可能包括使用替加环素、多粘菌素B或多粘菌素E（黏菌素）。由于多粘菌素具有潜在的肾毒性或神经毒性，临床医生应警惕预防其不良反应。鼓励临床医生支持美国传染病学会的10×'20倡议，以获得全球致力于未来开发更多抗菌药物的承诺。
