Bassetti Matteo, Luyt Charles-Edouard, Nicolau David P, Pugin Jérôme
Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy.
Service de Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Ann Intensive Care. 2016 Dec;6(1):35. doi: 10.1186/s13613-016-0140-x. Epub 2016 Apr 18.
Gram-negative pneumonia in patients who are intubated and mechanically ventilated is associated with increased morbidity and mortality as well as higher healthcare costs compared with those who do not have the disease. Intravenous antibiotics are currently the standard of care for pneumonia; however, increasing rates of multidrug resistance and limited penetration of some classes of antimicrobials into the lungs reduce the effectiveness of this treatment option, and current clinical cure rates are variable, while recurrence rates remain high. Inhaled antibiotics may have the potential to improve outcomes in this patient population, but their use is currently restricted by a lack of specifically formulated solutions for inhalation and a limited number of devices designed for the nebulization of antibiotics. In this article, we review the challenges clinicians face in the treatment of pneumonia and discuss the characteristics that would constitute an ideal inhaled drug/device combination. We also review inhaled antibiotic options currently in development for the treatment of pneumonia in patients who are intubated and mechanically ventilated.
与未患该病的患者相比，接受插管和机械通气的患者发生革兰氏阴性菌肺炎会增加发病率和死亡率，并导致更高的医疗成本。静脉注射抗生素是目前治疗肺炎的标准方法；然而，多重耐药率的上升以及某些类别的抗菌药物在肺部的渗透有限，降低了这种治疗方法的有效性，目前的临床治愈率各不相同，而复发率仍然很高。吸入性抗生素可能有改善这类患者治疗效果的潜力，但其使用目前受到缺乏专门配制的吸入溶液以及用于抗生素雾化的设备数量有限的限制。在本文中，我们回顾了临床医生在治疗肺炎时面临的挑战，并讨论了构成理想吸入药物/设备组合的特征。我们还回顾了目前正在研发的用于治疗接受插管和机械通气患者肺炎的吸入性抗生素选择。
