Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Center for Antimicrobial Resistance and Microbial Genomics (CARMiG), UTHealth McGovern Medical School, Houston, Texas, USA.
Pharmacotherapy. 2020 Sep;40(9):936-951. doi: 10.1002/phar.2447. Epub 2020 Aug 14.
Stenotrophomonas maltophilia, Burkholderia cepacia complex, Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., and Alcaligenes spp. are less-common non-lactose-fermenting bacteria that have emerged as important opportunistic pathogens. Patients at the highest risk for these infections include the immunocompromised, those with cystic fibrosis, and the critically ill. These opportunistic pathogens are frequently drug resistant through the expression of β-lactamases, multidrug efflux pumps, aminoglycoside-modifying enzymes, and target site alterations discussed in detail throughout this review. As a result, treatment is extremely challenging. For each pathogen, this review will examine the epidemiology, mechanisms of resistance, and in vitro and in vivo data including that for novel β-lactam/β-lactamase inhibitors and cefiderocol. Treatment recommendations are provided based on the available literature.
嗜麦芽窄食单胞菌、洋葱伯克霍尔德菌复合群、伊丽莎白菌属、黄杆菌属、不动杆菌属和产碱杆菌属是较少见的非乳糖发酵细菌，已成为重要的机会性致病菌。这些感染的高危人群包括免疫功能低下者、囊性纤维化患者和重症患者。这些机会致病菌通过表达β-内酰胺酶、多药外排泵、氨基糖苷修饰酶和靶位改变而经常产生耐药性，这在本综述中进行了详细讨论。因此，治疗极具挑战性。对于每种病原体，本综述将探讨其流行病学、耐药机制以及包括新型β-内酰胺/β-内酰胺酶抑制剂和头孢地尔科的体外和体内数据。根据现有文献提供了治疗建议。
