Pilmis Benoit, Jullien Vincent, Tabah Alexis, Zahar Jean-Ralph, Brun-Buisson Christian
Service de maladies infectieuses et tropicales, Hôpital Necker Enfants malades, Service de maladies infectieuses et tropicales, Université Paris Descartes, Paris, France.
Equipe mobile de microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Ann Intensive Care. 2017 Nov 10;7(1):113. doi: 10.1186/s13613-017-0334-x.
Several studies suggest that alternatives to carbapenems, and particulary beta-lactam/beta-lactamase inhibitor combinations, can be used for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)-related infections in non-ICU patients. Little is known concerning ICU patients in whom achieving the desired plasmatic pharmacokinetic/pharmacodynamic (PK/PD) target may be difficult. Also, in vitro susceptibility to beta-lactamase inhibitors might not translate into clinical efficacy. We reviewed the recent clinical studies examining the use of BL/BLI as alternatives to carbapenems for therapy of bloodstream infection, PK/PD data and discuss potential ecological benefit from avoiding the use of carbapenems. With the lack of prospective randomized studies, treating ICU patients with ESBL-PE-related infections using piperacillin-tazobactam should be done with caution. Current data suggest that BL/BLI empirical use should be avoided for therapy of ESBL-PE-related infection. Also, definitive therapy should be reserved to patients in clinical stable condition, after microbial documentation and results of susceptibility tests. Optimization of administration and higher dosage should be used in order to reach pharmacological targets.
多项研究表明，碳青霉烯类药物的替代药物，尤其是β-内酰胺类/β-内酰胺酶抑制剂联合制剂，可用于治疗非重症监护病房（ICU）患者中由产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）引起的感染。对于ICU患者，实现理想的血浆药代动力学/药效学（PK/PD）目标可能存在困难，这方面的了解较少。此外，对β-内酰胺酶抑制剂的体外敏感性可能无法转化为临床疗效。我们回顾了近期关于使用β-内酰胺类/β-内酰胺酶抑制剂联合制剂（BL/BLI）替代碳青霉烯类药物治疗血流感染的临床研究、PK/PD数据，并讨论了避免使用碳青霉烯类药物可能带来的潜在生态益处。由于缺乏前瞻性随机研究，使用哌拉西林-他唑巴坦治疗ICU中与ESBL-PE相关感染的患者时应谨慎。目前的数据表明，应避免将BL/BLI经验性用于治疗与ESBL-PE相关的感染。此外，在微生物鉴定及药敏试验结果出来后，确定性治疗应仅用于临床状况稳定的患者。应优化给药方式并使用更高剂量，以达到药理学目标。
