Al Salman Jameela, Al Dabal Laila, Bassetti Matteo, Alfouzan Wadha A, Al Maslamani Muna, Alraddadi Basem, Elhoufi Ashraf, Enani Mushira, Khamis Faryal Ali, Mokkadas Eiman, Romany Ingy, Somily Ali, Kanj Souha
Arabian Gulf University, Manama, Bahrain.
Rashid Hospital, Dubai, United Arab Emirates.
Int J Antimicrob Agents. 2020 Oct;56(4):106104. doi: 10.1016/j.ijantimicag.2020.106104. Epub 2020 Jul 25.
Antimicrobial resistance is an important global issue that impacts the efficacy of established antimicrobial therapy. This is true globally and within the Arab countries of the Middle East, where a range of key Gram-negative pathogens pose challenges to effective therapy. There is a need to establish effective treatment recommendations for this region given specific challenges to antimicrobial therapy, including variations in the availability of antimicrobials, infrastructure and specialist expertise. This consensus provides regional recommendations for the first-line treatment of hospitalized patients with serious infections caused by World Health Organization critical priority Gram-negative pathogens Acinetobacter baumannii and Pseudomonas aeruginosa resistant to carbapenems, and Enterobacteriaceae resistant to carbapenems and third-generation cephalosporins. A working group comprising experts in infectious disease across the region was assembled to review contemporary literature and provide additional consensus on the treatment of key pathogens. Detailed therapeutic recommendations are formulated for these pathogens with a focus on bacteraemia, nosocomial pneumonia, urinary tract infections, skin and soft tissue infections, and intra-abdominal infections. First-line treatment options are provided, along with alternative agents that may be used where variations in antimicrobial availability exist or where local preferences and resistance patterns should be considered. These recommendations take into consideration the diverse social and healthcare structures of the Arab countries of the Middle East, meeting a need that is not filled by international guidelines. There is a need for these recommendations to be updated continually to reflect changes in antimicrobial resistance in the region, as well as drug availability and emerging data from clinical trials.
抗菌药物耐药性是一个重要的全球性问题，影响着现有抗菌治疗的效果。在全球范围内以及中东的阿拉伯国家都是如此，在这些国家，一系列关键的革兰氏阴性病原体给有效治疗带来了挑战。鉴于抗菌治疗面临的特定挑战，包括抗菌药物的可及性、基础设施和专业知识的差异，有必要为该地区制定有效的治疗建议。本共识为因对碳青霉烯类耐药的世界卫生组织关键优先革兰氏阴性病原体鲍曼不动杆菌和铜绿假单胞菌，以及对碳青霉烯类和第三代头孢菌素耐药的肠杆菌科细菌引起的严重感染的住院患者的一线治疗提供了区域建议。组建了一个由该地区传染病专家组成的工作组，以审查当代文献，并就关键病原体的治疗提供更多共识。针对这些病原体制定了详细的治疗建议，重点关注菌血症、医院获得性肺炎、尿路感染、皮肤和软组织感染以及腹腔内感染。提供了一线治疗方案，以及在抗菌药物可及性存在差异或应考虑当地偏好和耐药模式的情况下可使用的替代药物。这些建议考虑到了中东阿拉伯国家多样的社会和医疗结构，满足了国际指南未涵盖的需求。需要不断更新这些建议，以反映该地区抗菌药物耐药性的变化、药物可及性以及临床试验的新数据。
