Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Future Microbiol. 2011 Jun;6(6):653-66. doi: 10.2217/fmb.11.49.
Enterobacteriaceae that produce serine carbapenemases or metallo-β-lactamases, such as KPC, OXA-48, VIM or NDM, respectively, are spreading mostly as nosocomial pathogens worldwide. Such strains are typically resistant to most if not all available antimicrobials. Specific relevant clinical data are scarce to guide the determination of the most appropriate treatment options. Data on antimicrobial susceptibility, resistance development, synergy, pharmacokinetic and pharmacodynamic parameters of the candidate regimens, as well as the experience from the treatment of infections with nonfermenting Gram-negative pathogens, can aid in this regard. Colistin and tigecycline are most likely to be active in vitro against Enterobacteriaceae producing carbapenem-hydrolyzing β-lactamases, but resistance development is of concern. Individual members of the aminoglycoside class can also be active in vitro, while carbapenems or aztreonam (specifically for metallo-β-lactamase producers) can have low minimum inhibitory concentrations. Current data do not reliably support the use of these agents as monotherapy for systemic infections. Several expanded-spectrum cephalosporins, such as ceftazidime, may be active against OXA-48 type producers. Fosfomycin might be useful as a last-resort option as part of combination regimens. Combination antimicrobial therapy with agents exhibiting synergy might also be of benefit, until novel effective agents could become clinically available.
肠杆菌科产生丝氨酸碳青霉烯酶或金属β-内酰胺酶的细菌，分别为 KPC、OXA-48、VIM 或 NDM 等，正在全球范围内主要作为医院获得性病原体传播。这些菌株通常对大多数甚至所有可用的抗菌药物具有耐药性。缺乏特定的相关临床数据来指导确定最合适的治疗方案。关于抗菌药物敏感性、耐药性发展、协同作用、候选方案的药代动力学和药效学参数，以及治疗非发酵革兰氏阴性病原体感染的经验，可以为此提供帮助。多粘菌素和替加环素最有可能对产碳青霉烯水解β-内酰胺酶的肠杆菌科具有体外活性，但耐药性的发展令人担忧。氨基糖苷类药物的个别成员也可能具有体外活性，而碳青霉烯类或氨曲南（专门针对金属β-内酰胺酶产生菌）可能具有较低的最低抑菌浓度。目前的数据不能可靠地支持将这些药物作为全身感染的单一疗法使用。几种扩展谱头孢菌素，如头孢他啶，可能对 OXA-48 型产生菌具有活性。磷霉素可能作为联合治疗方案的最后手段之一有用。具有协同作用的联合抗菌治疗也可能有益，直到新的有效药物在临床上可用。
