Département d'anesthésie-réanimation, CHU Bichat-Claude Bernard, APHP, Université Paris Diderot, PRESS Sorbonne Cité, INSERM UMR 1152, Paris, France.
Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
Curr Opin Infect Dis. 2018 Dec;31(6):587-593. doi: 10.1097/QCO.0000000000000490.
The worldwide spread of extended-spectrum beta-lactamase (ESBL)-producing bacteria, the overuse of carbapenems, the emergence of carbapenemase-producing organisms and the growing importance of multidrug-resistant and/or extended drug-resistant strains have totally changed prescribers' habits, leading to very few treatment options in many cases. Beta-lactam/beta-lactamase inhibitor (BLBLI) combinations should be considered as an alternative to carbapenems for treating ESBL-producing bacteria and Pseudomonas aeruginosa infections. The purpose of this study was to provide insight concerning the patients who would constitute ideal candidates to receive these new BLBLI combinations.
Ceftolozane/tazobactam and ceftazidime/avibactam are the first drugs constituting the use of new beta-lactamase inhibitors. Ceftolozane/tazobactam is the drug of choice for treating MDR/XDR P. aeruginosa infections. Ceftazidime/avibactam is the best drug available for treating KPC and OXA-48 carbapenemase-producing Enterobacteriaceae. Ceftolozane/tazobactam and ceftazidime/avibactam are both carbapenem-sparing agents for treating ESBL-producing Enterobacteriaceae. The role of carbapenem/inhibitors remains to be clarified.
Each BLBLI combination has distinctive specificities and limitations that need to be investigated cautiously. Randomized trials will play a key role in defining the best strategies. Infection control measures and prompt diagnosis remain fundamental to prevent dissemination of MDR pathogens in healthcare settings and to optimize early antimicrobial treatment.
产Extended-spectrum beta-lactamase (ESBL)的细菌在全球范围内的传播、碳青霉烯类药物的过度使用、产碳青霉烯酶的生物体的出现以及多药耐药和/或广泛耐药菌株的重要性不断增加，这些都彻底改变了临床医生的用药习惯，导致许多情况下的治疗选择非常有限。对于产 ESBL 的细菌和铜绿假单胞菌感染，β-内酰胺/β-内酰胺酶抑制剂（BLBLI）联合用药可作为碳青霉烯类药物的替代方案。本研究的目的是为那些可能成为这些新型 BLBLI 联合用药理想候选者的患者提供一些见解。
头孢洛扎/他唑巴坦和头孢他啶/阿维巴坦是首批使用新型β-内酰胺酶抑制剂的药物。头孢洛扎/他唑巴坦是治疗多药耐药/广泛耐药铜绿假单胞菌感染的首选药物。头孢他啶/阿维巴坦是治疗 KPC 和 OXA-48 碳青霉烯酶产生的肠杆菌科细菌的最佳药物。头孢洛扎/他唑巴坦和头孢他啶/阿维巴坦均为治疗产 ESBL 的肠杆菌科细菌的碳青霉烯类药物节约剂。碳青霉烯/抑制剂的作用仍需进一步阐明。
每种 BLBLI 联合用药都有其独特的特点和局限性，需要谨慎研究。随机试验将在确定最佳策略方面发挥关键作用。感染控制措施和及时诊断仍然是防止医疗保健环境中多药耐药病原体传播和优化早期抗菌治疗的基础。
