Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Curr Opin Infect Dis. 2020 Dec;33(6):464-473. doi: 10.1097/QCO.0000000000000677.
Pseudomonas aeruginosa is one of the most feared nosocomial pathogens. Treatment of P. aeruginosa infections is challenging because of the limited choices of antibiotics and the emergent resistance of the pathogen. The present review aims at addressing the management of P. aeruginosa infections and highlighting the novel antibiotics that show a future promising role.
Novel fluoroquinolones have been recently introduced and show favorable activity. New combinations of β-lactams/β-lactamase inhibitors have been studied in various indications of infections because of P. aeruginosa. Cefiderocol, a new cephalosporin, shows very promising results against P. aeruginosa. Currently, combination therapy is only recommended in limited scenarios. Extended-infusion of β-lactams exhibit clinical benefit. Bacteriophage therapy is a growing field of interest and may have an impactful effect on the treatment of resistant P. aeruginosa.
Factors that guide clinical decisions for empiric and directed P. aeruginosa therapy include the epidemiology, the patient's risk factors, the site of infection, and the available treatment options. Conventional antipseudomonal antibiotics have been used successfully for a long time, but the increase in worldwide resistance necessitates the need for newer agents. Antimicrobial stewardship is essential to preserve the new drugs and prevent future development of resistance.
铜绿假单胞菌是一种最令人恐惧的医院获得性病原体。由于抗生素选择有限和病原体的耐药性不断出现，铜绿假单胞菌感染的治疗具有挑战性。本综述旨在讨论铜绿假单胞菌感染的管理，并强调具有未来应用前景的新型抗生素。
新型氟喹诺酮类药物已被引入，显示出良好的活性。由于铜绿假单胞菌，各种感染适应症的β-内酰胺/β-内酰胺酶抑制剂新组合已被研究。新型头孢菌素头孢地尔可针对铜绿假单胞菌显示出非常有前景的结果。目前，仅在有限的情况下推荐联合治疗。β-内酰胺类药物的延长输注显示出临床获益。噬菌体治疗是一个日益引起关注的领域，可能对治疗耐药铜绿假单胞菌产生重大影响。
指导铜绿假单胞菌经验性和靶向治疗临床决策的因素包括流行病学、患者的危险因素、感染部位和可用的治疗选择。传统的抗假单胞菌抗生素已经成功使用了很长时间，但全球耐药性的增加需要新型药物。抗菌药物管理对于保护新药和预防未来耐药性的发展至关重要。
