Internal Medicine, University of Campania 'L. Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
Internal Medicine, University of Campania 'L. Vanvitelli' & Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
Clin Microbiol Infect. 2019 Aug;25(8):943-950. doi: 10.1016/j.cmi.2019.04.013. Epub 2019 Apr 18.
Carbapenem resistance is defined as in vitro non-susceptibility to any carbapenem and/or documented production of a carbapenemase. This feature has rapidly spread worldwide among clinical isolates of Enterobacteriaceae, mostly Klebsiella spp., and is associated with diverse molecular mechanisms. Carbapenem resistance is often associated with resistance to all traditional β-lactams and other classes of antibiotics, denoting a typical example of an extensively drug-resistant phenotype.
To summarize and interpret in a balanced manner the most clinically relevant data in terms of carbapenem-resistant Enterobacteriaceae (CRE) infection management.
Data were extracted by PubMed and clinicaltrials.gov search and manual scrutiny among references of analysed articles.
Features of newer and older, rediscovered antimicrobial options for CRE are described. Observational studies and randomized clinical trials (RCT) of CRE treatment are summarized, with a specific focus on the effects of monotherapy compared with combination treatment.
The available evidence on the current management of CRE mostly comes from observational, non-comparative, retrospective, small studies, with a high risk of selection bias. Very little evidence comes from RCT. Conflicting results of RCT and observational studies call for caution before combination therapies are deemed superior to monotherapy. Data on newer agents have spurred enthusiasm but remain limited as concerns severe CRE infections. A balanced approach should guide the clinician in the choice of old or new drugs, and of monotherapies or combination regimens. Efforts should be made to perform adequately sized clinical trials answering well-defined research questions.
碳青霉烯类耐药被定义为对任何碳青霉烯类药物的体外非敏感性和/或有记录的碳青霉烯酶的产生。这一特征在肠杆菌科的临床分离株中迅速在全球范围内传播，主要是克氏杆菌属，与多种分子机制有关。碳青霉烯类耐药通常与对所有传统β-内酰胺类药物和其他类别的抗生素的耐药性相关，代表了一种广泛耐药表型的典型例子。
以平衡的方式总结和解释与碳青霉烯类耐药肠杆菌科（CRE）感染管理相关的最具临床相关性的数据。
通过 PubMed 和 clinicaltrials.gov 搜索以及对分析文章参考文献的手动审查提取数据。
描述了针对 CRE 的新型和旧型、重新发现的抗菌药物选择的特点。总结了 CRE 治疗的观察性研究和随机临床试验（RCT），特别关注与联合治疗相比，单药治疗的效果。
关于 CRE 目前管理的现有证据主要来自观察性、非对照、回顾性、小样本研究，存在选择偏倚的高风险。只有很少的证据来自 RCT。RCT 和观察性研究的结果相互矛盾，在认为联合治疗优于单药治疗之前需要谨慎。关于新型药物的数据激发了热情，但在严重 CRE 感染方面仍然有限。平衡的方法应该指导临床医生在选择旧药或新药、单药治疗或联合治疗方案时做出选择。应努力进行充分规模的临床试验，以解决明确的研究问题。
