Lupia Tommaso, Corcione Silvia, Mornese Pinna Simone, De Rosa Francesco Giuseppe
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
School of Medicine, Tufts University, Boston, MA, USA.
J Thorac Dis. 2020 Jul;12(7):3747-3763. doi: 10.21037/jtd-20-417.
The burden of hospital admission for pneumonia in internal medicine wards may not be underestimated; otherwise, cases of pneumonia are a frequent indication for antimicrobial prescriptions. Community- and hospital-acquired pneumonia are characterized by high healthcare costs, morbidity and non-negligible rates of fatality. The overcoming prevalence of resistant gram-negative and positive bacteria (e.g., methicillin-resistant , penicillin and ceftriaxone-resistant , extended-spectrum β-lactamases and carbapenemases producing ) has made the most of the first-line agents ineffective for treating lower respiratory tract infections. A broad-spectrum of activity, favourable pulmonary penetration, harmlessness and avoiding in some cases a combination therapy, characterise new cephalosporins such as ceftolozane/tazobactam, ceftobiprole, ceftazidime/avibactam and ceftaroline. We aimed to summarise the role and place in therapy of new cephalosporins in community- and hospital-acquired pneumonia within the setting of internal medicine wards. The "universal pneumonia antibiotic strategy" is no longer acceptable for treating lung infections. Antimicrobial therapy should be individualized considering local antimicrobial resistance and epidemiology, the stage of the illness and potential host factors predisposing to a high risk for specific pathogens.
内科病房中因肺炎住院的负担不可低估；否则，肺炎病例是抗菌药物处方的常见指征。社区获得性肺炎和医院获得性肺炎的特点是医疗成本高、发病率高且死亡率不可忽视。耐革兰氏阴性和阳性细菌（如耐甲氧西林、耐青霉素和头孢曲松、产超广谱β-内酰胺酶和碳青霉烯酶）的普遍存在使得大多数一线药物对治疗下呼吸道感染无效。新型头孢菌素如头孢洛扎/他唑巴坦、头孢比普、头孢他啶/阿维巴坦和头孢洛林具有广泛的活性、良好的肺部穿透力、安全性以及在某些情况下可避免联合治疗的特点。我们旨在总结新型头孢菌素在社区获得性肺炎和医院获得性肺炎内科病房治疗中的作用和地位。“通用肺炎抗生素策略”已不再适用于治疗肺部感染。抗菌治疗应根据当地的抗菌药物耐药性和流行病学、疾病阶段以及导致特定病原体高风险的潜在宿主因素进行个体化。
