Doi Yohei, Paterson David L
Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
The University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Semin Respir Crit Care Med. 2015 Feb;36(1):74-84. doi: 10.1055/s-0035-1544208. Epub 2015 Feb 2.
Carbapenemase-producing Enterobacteriaceae (CPE) were almost nonexistent up to the 1990s, but are today encountered routinely in hospitals and other healthcare facilities in many countries including the United States. KPC-producing Klebsiella pneumoniae was the first to emerge and spread globally and is endemic in the United States, Israel, Greece, and Italy. Recently, NDM-producing Enterobacteriaceae and OXA-48-producing K. pneumoniae appear to be disseminating from South Asia and Northern Africa, respectively. They are almost always resistant to all β-lactams including carbapenems and many other classes. Mortality from invasive CPE infections reaches up to 40%. To obtain the maximal benefit from the limited options available, dosing of antimicrobial agents should be optimized based on pharmacokinetic data, especially for colistin and carbapenems. In addition, multiple observational studies have associated combination antimicrobial therapy with lower mortality compared with monotherapy for these infections. The outcomes appear to be especially favorable when patients are treated with a carbapenem and a second agent such as colistin, tigecycline, and gentamicin, but the best approach is yet to be defined.
产碳青霉烯酶肠杆菌科细菌（CPE）在20世纪90年代之前几乎不存在，但如今在包括美国在内的许多国家的医院和其他医疗机构中经常遇到。产KPC的肺炎克雷伯菌是最早出现并在全球传播的，在美国、以色列、希腊和意大利呈地方性流行。最近，产NDM的肠杆菌科细菌和产OXA - 48的肺炎克雷伯菌似乎分别从南亚和北非传播开来。它们几乎总是对包括碳青霉烯类在内的所有β-内酰胺类以及许多其他类别的抗菌药物耐药。侵袭性CPE感染的死亡率高达40%。为了从有限的可用选择中获得最大益处，抗菌药物的给药应根据药代动力学数据进行优化，特别是对于黏菌素和碳青霉烯类。此外，多项观察性研究表明，与这些感染的单药治疗相比，联合抗菌治疗与较低的死亡率相关。当患者接受碳青霉烯类与第二种药物如黏菌素、替加环素和庆大霉素联合治疗时，结果似乎特别有利，但最佳方法尚未确定。
