Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
Curr Opin Infect Dis. 2018 Apr;31(2):177-186. doi: 10.1097/QCO.0000000000000438.
Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) bacteria represents a global emerging problem. Delayed prescription of an adequate treatment for VAP has been associated with higher morbidity and mortality. New molecules have been developed to face the need of compounds that are active against resistant Gram-positive and Gram-negative pathogens. The aim of this review is to summarize the current scenario of new therapeutic options for the treatment of VAP.
A number of new antibiotics with activity against MDR have been recently approved for the treatment of VAP, and other agents are under investigation. In this review, the authors summarize the current therapeutic options for the treatment of VAP that showed promising implications for clinical practice, including new compounds belonging to old antibiotic classes (e.g., ceftolozane/tazobactam, ceftazidime/avibactam meropenem/vaborbactam, imipenem/relebactam, tedizolid, cefiderocol, eravacycline, and plazomicin) and novel chemical classes, such as murepavadin. Nebulized antibiotics that are currently in development for the treatment of pneumonia in mechanically ventilated patients are also presented.
Newly approved and investigational drugs for the treatment of VAP are expected to offer many advantages for the management of patients with respiratory infections caused by MDR. Promising characteristics of new compounds include high activity against both methicillin-resistant Staphylococcus aureus and MDR Gram-negative bacteria and a favorable safety profile.
由耐多药（MDR）细菌引起的呼吸机相关性肺炎（VAP）是一个全球性的新兴问题。VAP 治疗中延迟处方适当的治疗药物与更高的发病率和死亡率有关。为了应对需要针对耐药革兰阳性和革兰阴性病原体具有活性的化合物，已经开发出了新的分子。本文旨在总结治疗 VAP 的新治疗选择的最新进展。
最近有许多具有抗 MDR 活性的新抗生素被批准用于治疗 VAP，还有其他药物正在研究中。在这篇综述中，作者总结了目前治疗 VAP 的治疗选择，这些选择对临床实践具有重要意义，包括属于旧抗生素类别的新化合物（例如头孢洛扎/他唑巴坦、头孢他啶/阿维巴坦、美罗培南/沃巴坦、比阿培南、头孢地尔、依拉环素和普拉佐米星）和新型化学类别，如 murepavadin。目前正在开发用于治疗机械通气患者肺炎的雾化抗生素也在本文中进行了介绍。
用于治疗 VAP 的新批准和研究药物有望为治疗由 MDR 引起的呼吸道感染患者提供许多优势。新化合物的有前途的特点包括对耐甲氧西林金黄色葡萄球菌和 MDR 革兰阴性菌具有高活性和良好的安全性。
