Monnier Annelie A, Tacconelli Evelina, Årdal Christine, Cavaleri Marco, Gyssens Inge C
Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium.
JAC Antimicrob Resist. 2020 Jun 19;2(2):dlaa034. doi: 10.1093/jacamr/dlaa034. eCollection 2020 Jun.
This case study addresses: (i) antibiotic treatment options for bacteraemia (SAB), for both empirical and targeted therapy; (ii) the current status of and priorities for the antibiotic pipeline to ensure access of effective antibiotics for SAB; and (iii) strategies for responsible antibiotic use relevant to the clinical management of SAB.
Evidence to address the aims was extracted from the following information sources: (i) EUCAST and CLSI recommendations, summaries of product characteristics (SPCs), antibiotic treatment guidelines and the textbook ; (ii) the www.clinicaltrial.gov database; and (iii) quality indicators for responsible antibiotic use.
Current monotherapy treatment options for SAB include only three drug classes (β-lactams, glycopeptides and lipopeptides), of which two also cover MRSA bacteraemia (glycopeptides and lipopeptides). The analysis of the antibiotic pipeline and ongoing clinical trials revealed that several new antibiotics with (including MRSA) coverage were developed in the past decade (2009-19). However, none belonged to a new antibiotic class or had superior effectiveness and their added clinical value for SAB remains to be proven. Responsible antibiotic use for the treatment of SAB was illustrated using 11 quality indicators.
Awareness of the problem of a limited antibiotic arsenal, together with incentives (e.g. push incentives), is needed to steer the R&D landscape towards the development of novel and effective antibiotics for treating SAB. In the meantime, responsible antibiotic use guided by quality indicators should preserve the effectiveness of currently available antibiotics for treating SAB.
本案例研究涉及：（i）针对血流感染（SAB）的经验性和靶向性治疗的抗生素治疗选择；（ii）抗生素研发渠道的现状和优先事项，以确保获得用于治疗SAB的有效抗生素；以及（iii）与SAB临床管理相关的合理使用抗生素策略。
为实现这些目标，从以下信息来源提取证据：（i）欧洲抗菌药物敏感性试验委员会（EUCAST）和美国临床和实验室标准协会（CLSI）的建议、产品特性摘要（SPC）、抗生素治疗指南和教科书；（ii）www.clinicaltrial.gov数据库；以及（iii）合理使用抗生素的质量指标。
目前SAB的单药治疗选择仅包括三类药物（β-内酰胺类、糖肽类和脂肽类），其中两类也涵盖耐甲氧西林金黄色葡萄球菌血流感染（糖肽类和脂肽类）。对抗生素研发渠道和正在进行的临床试验的分析表明，在过去十年（2009 - 2019年）中开发了几种具有（包括耐甲氧西林金黄色葡萄球菌）覆盖范围的新型抗生素。然而，没有一种属于新的抗生素类别，也没有更高的疗效，其对SAB的额外临床价值仍有待证实。使用11项质量指标说明了SAB治疗中合理使用抗生素的情况。
需要认识到抗生素储备有限的问题，并通过激励措施（如推动激励）来引导研发方向，以开发用于治疗SAB的新型有效抗生素。与此同时，以质量指标为指导的合理使用抗生素应保持目前可用抗生素治疗SAB的有效性。
