Levy Hara Gabriel, Gould Ian, Endimiani Andrea, Pardo Pilar Ramón, Daikos George, Hsueh Po-Ren, Mehtar Shaheen, Petrikkos George, Casellas José María, Daciuk Lucía, Paciel Daniela, Novelli Andrea, Saginur Raphael, Pryluka Daniel, Medina Julio, Savio Eduardo
Infectious Diseases Unit, Hospital Carlos Durand, Buenos Aires City, Argentina.
J Chemother. 2013 Jun;25(3):129-40. doi: 10.1179/1973947812Y.0000000062.
The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased during the past 10 years. Its detection is frequently difficult, because they do not always show a minimum inhibitory concentration (MIC) value for carbapenems in the resistance range. Both broth microdilution and agar dilution methods are more sensitive than disk diffusion method, Etest and automated systems. Studies on antimicrobial treatment are based on a limited number of patients; therefore, the optimal treatment is not well established. Combination therapy with two active drugs appears to be more effective than monotherapy. Combination of a carbapenem with another active agent--preferentially an aminoglycoside or colistin--could lower mortality provided that the MIC is ≤4 mg/l and probably ≤8 mg/l, and is administered in a higher-dose/prolonged-infusion regimen. An aggressive infection control and prevention strategy is recommended, including reinforcement of hand hygiene, using contact precautions and early detection of CPE through use of targeted surveillance.
在过去10年中，产碳青霉烯酶肠杆菌科细菌（CPE）的流行率有所上升。其检测常常很困难，因为它们在耐药范围内对碳青霉烯类药物的最低抑菌浓度（MIC）值并不总是表现出来。肉汤微量稀释法和琼脂稀释法都比纸片扩散法、Etest法和自动化系统更敏感。关于抗菌治疗的研究是基于有限数量的患者进行的；因此，最佳治疗方案尚未明确确立。两种有效药物的联合治疗似乎比单一疗法更有效。碳青霉烯类药物与另一种活性剂（优先选择氨基糖苷类药物或黏菌素）联合使用，只要MIC≤4mg/L且可能≤8mg/L，并采用高剂量/延长输注方案给药，就可以降低死亡率。建议采取积极的感染控制和预防策略，包括加强手卫生、采取接触预防措施以及通过针对性监测早期发现CPE。
