Policlinico Umberto I," Sapienza"University of Rome, Rome, Italy.
Department of Health Sciences, University of Genoa, Genoa, Italy.
Expert Rev Anti Infect Ther. 2021 Aug;19(8):983-991. doi: 10.1080/14787210.2021.1874918. Epub 2021 Feb 17.
: The widespread increase in resistance to β-lactam antibiotics in currently represents one of the main threats to human health worldwide. The primary mechanisms of resistance are the production of β-lactamase enzymes that are able to hydrolyze β-lactams.: we summarize the most recent advances regarding the main characteristics and spectrum of activity of new available antibiotics and strategies for the treatment of ESBL-producing infections.: ESBL-producing strains are recognized as a worldwide challenge in the treatment of both hospital- and community-acquired infections. Data from the literature point out the high mortality associated with severe infections due to ESBL strains, especially in patients who developed severe sepsis or septic shock, together with the importance of the source of infection and indicators of severity, as determinants of the patient's outcome. Carbapenems are currently considered the first-line therapy, although the diffusion of resistant strains is an evolving problem and is mandatory the introduction in clinical practice of new drug regimens and treatment strategies, based on clinical data, local epidemiology, and microbiology. As a possible carbapenem-sparing strategy, ceftolozane-tazobactam and ceftazidime-avibactam appear the best-available carbapenem-sparing therapies. The definitive role of new drugs should be definitively assessed.
目前，β-内酰胺类抗生素耐药性的广泛增加是对全球人类健康的主要威胁之一。耐药的主要机制是产生能够水解β-内酰胺类抗生素的β-内酰胺酶。我们总结了关于新型抗生素的主要特性和活性谱以及治疗产 ESBL 菌感染的策略的最新进展。产 ESBL 菌被认为是治疗医院获得性和社区获得性感染的全球性挑战。文献中的数据表明，由于 ESBL 株引起的严重感染与高死亡率相关，尤其是在发生严重脓毒症或感染性休克的患者中，感染源和严重程度指标作为决定患者预后的决定因素非常重要。碳青霉烯类目前被认为是一线治疗药物，尽管耐药菌株的扩散是一个不断发展的问题，必须根据临床数据、当地流行病学和微生物学，在临床实践中引入新的药物方案和治疗策略。作为一种可能的碳青霉烯类节约策略，头孢洛扎他唑巴坦和头孢他啶-阿维巴坦似乎是最好的碳青霉烯类节约治疗方法。新药物的明确作用应进行明确评估。
