Corcione Silvia, Lupia Tommaso, De Rosa Francesco Giuseppe
Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
Tufts University School of Medicine, Boston, MA, United States.
Front Med (Lausanne). 2021 May 7;8:617378. doi: 10.3389/fmed.2021.617378. eCollection 2021.
In past decade, cephalosporins have developed significantly, and data regarding novel cephalosporins (i.e., ceftobiprole, ceftaroline, ceftolozane/tazobactam, ceftazidime/avibactam, and cefiderocol) within septic and bacteremic subjects are rising. These compounds generally offer very promising microbiological susceptibility, although the variability among gram-negative and -positive strains of different cohorts is noticed in the literature. We require further pharmacological data to measure the best dose in order to prevent sub-therapeutic drug levels in critically ill patients. These new compounds in theory are the sparing solution in the infection group for different antimicrobial classes such as aminoglycosides notably within endovascular and GNB-bacteremias, as well as colistin and carbapenem-sparing strategies, favoring good safety profile molecules. Moreover, new cephalosporins are the basis for the actual indications to open up new and exciting prospects for serious infections in the future. In future, patients will be addressed with the desirable approach to sepsis and serious infections in terms of their clinical situation, inherent features of the host, the sensitivity profile, and local epidemiology, for which evidence of the use of new cephalosporin in the treatment of severe infections will fill the remaining gaps.
在过去十年中,头孢菌素取得了显著发展,关于新型头孢菌素(即头孢托罗、头孢洛林、头孢他啶/阿维巴坦、头孢洛扎/他唑巴坦和头孢地尔)在脓毒症和菌血症患者中的数据不断增加。这些化合物通常具有非常可观的微生物敏感性,尽管文献中注意到不同队列的革兰氏阴性和阳性菌株之间存在差异。我们需要进一步的药理学数据来确定最佳剂量,以防止重症患者出现亚治疗性药物水平。从理论上讲,这些新化合物是不同抗菌类别(如氨基糖苷类,特别是在血管内感染和革兰氏阴性菌血症中)感染组的替代解决方案,以及多粘菌素和碳青霉烯类药物节省策略,有利于安全性良好的分子。此外,新型头孢菌素是未来为严重感染开辟新的、令人兴奋前景的实际适应症的基础。未来,将根据患者的临床情况、宿主的固有特征、敏感性概况和当地流行病学,以理想的方法治疗脓毒症和严重感染,而新型头孢菌素用于治疗严重感染的证据将填补其余空白。