Russo Alessandro, Trecarichi Enrico Maria, Torti Carlo
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy.
Curr Opin Infect Dis. 2022 Apr 1;35(2):95-102. doi: 10.1097/QCO.0000000000000807.
Skin and soft tissue infections (SSTIs) are a leading cause of morbidity, emergency department visits and hospitalization. In recent years, the spread of carbapenem-resistant gram-negative bacteria (GNB) is also increasing in SSTIs. However, the armamentarium of available drugs is recently expanding as well. In this review, we reported the most recent data and about management and treatment of SSTIs caused by GNB, mainly for the treatment of carbapenem-resistant Enterobacterales (CRE), Pseudomonas spp and Acinetobacter spp.
The increasing incidence of carbapenem-resistant GNB is challenging for management and treatment, considering the high rate of inappropriate empiric and targeted antimicrobial treatments. The role of new antibiotics, mainly licensed for the treatment of other infections, is an object of continuous debate. As a matter of fact, no specific clinical trials on SSTIs have been performed for new drugs; however, recent data about the use in real life of new compounds in clinical practice are available.
Some recently approved drugs are actually considered the backbone of targeted therapy in patients with severe infections caused by susceptible carbapenem-resistant GNB strains. Prompt diagnosis of cSSTIs is crucial and, when necessary, surgical debridement for source control of infection is the milestone of the treatment. The physicians should be confident to identify patients at high risk for multidrug-resistant pathogens to minimize inappropriate empiric therapy.
皮肤和软组织感染（SSTIs）是发病、急诊就诊和住院的主要原因。近年来，碳青霉烯耐药革兰氏阴性菌（GNB）在SSTIs中的传播也在增加。然而，可用药物的种类最近也在扩大。在本综述中，我们报告了关于GNB引起的SSTIs的管理和治疗的最新数据，主要针对耐碳青霉烯肠杆菌科细菌（CRE）、假单胞菌属和不动杆菌属的治疗。
考虑到不适当的经验性和靶向性抗菌治疗的高发生率，碳青霉烯耐药GNB发病率的增加对管理和治疗构成挑战。主要用于治疗其他感染的新型抗生素的作用一直是持续争论的焦点。事实上，尚未针对新药进行关于SSTIs的具体临床试验；然而，最近有关于新化合物在临床实践中的实际应用数据。
一些最近获批的药物实际上被认为是由敏感的碳青霉烯耐药GNB菌株引起的严重感染患者靶向治疗的支柱。及时诊断复杂性SSTIs至关重要，必要时手术清创以控制感染源是治疗的关键。医生应自信地识别出多药耐药病原体高危患者，以尽量减少不适当的经验性治疗。
