Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
Clin Microbiol Infect. 2019 Aug;25(8):932-942. doi: 10.1016/j.cmi.2019.03.030. Epub 2019 Apr 12.
Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are a frequent cause of invasive infections worldwide. Carbapenems are nowadays the most used drugs to treat these infections. However, due to the increasing rates of resistance to these antimicrobials, carbapenem-sparing alternatives are being investigated.
The aim of this narrative literature review is to summarize the published information on the currently available antibiotics for the treatment of ESBL-E infections, providing specific information on three subgroups of patients: Group 1, patients with severe infections or infections from high-risk sources or in severely immunocompromised patients; Group 2, patients with non-severe infections from intermediate-risk source; and Group 3, patients with non-severe urinary tract infection.
For patients in Group 1, the current data would support the use of carbapenems. For milder infections, however, particularly urinary tract infections, other non-carbapenem antibiotics can be considered in selected cases, including beta-lactam/beta-lactam inhibitor combinations, cephamycins, temocillin and aminoglycosides. While specific studies should be performed in these situations, individualized decisions may be taken in order to avoid overuse of carbapenems.
产超广谱β-内酰胺酶肠杆菌科（ESBL-E）是全球侵袭性感染的常见病因。碳青霉烯类抗生素目前是治疗这些感染的最常用药物。然而，由于这些抗菌药物耐药率的不断增加，正在研究碳青霉烯类药物的替代药物。
本综述性文献旨在总结目前可用于治疗 ESBL-E 感染的抗生素信息，为三组患者提供具体信息：第 1 组，患有严重感染或来自高危源感染或严重免疫功能低下的患者；第 2 组，患有来自中危源的非严重感染的患者；第 3 组，患有非严重尿路感染的患者。
对于第 1 组患者，目前的数据支持使用碳青霉烯类药物。然而，对于较轻的感染，特别是尿路感染，在某些情况下可以考虑使用其他非碳青霉烯类抗生素，包括β-内酰胺/β-内酰胺抑制剂联合制剂、头孢菌素类、替莫西林和氨基糖苷类。虽然在这些情况下应进行具体研究，但可以根据需要做出个体化决策，以避免碳青霉烯类药物的过度使用。
