Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Clinical Pathology Laboratory, ASST Valle Olona, Busto Arsizio, Italy.
Int J Antimicrob Agents. 2022 Aug;60(2):106611. doi: 10.1016/j.ijantimicag.2022.106611. Epub 2022 Jun 11.
Management of patients with infections caused by multidrug-resistant organisms is challenging and requires a multidisciplinary approach to achieve successful clinical outcomes. The aim of this paper is to provide recommendations for the diagnosis and optimal management of these infections, with a focus on targeted antibiotic therapy. The document was produced by a panel of experts nominated by the five endorsing Italian societies, namely the Italian Association of Clinical Microbiologists (AMCLI), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Society of Microbiology (SIM), the Italian Society of Infectious and Tropical Diseases (SIMIT) and the Italian Society of Anti-Infective Therapy (SITA). Population, Intervention, Comparison and Outcomes (PICO) questions about microbiological diagnosis, pharmacological strategies and targeted antibiotic therapy were addressed for the following pathogens: carbapenem-resistant Enterobacterales; carbapenem-resistant Pseudomonas aeruginosa; carbapenem-resistant Acinetobacter baumannii; and methicillin-resistant Staphylococcus aureus. A systematic review of the literature published from January 2011 to November 2020 was guided by the PICO strategy. As data from randomised controlled trials (RCTs) were expected to be limited, observational studies were also reviewed. The certainty of evidence was classified using the GRADE approach. Recommendations were classified as strong or conditional. Detailed recommendations were formulated for each pathogen. The majority of available RCTs have serious risk of bias, and many observational studies have several limitations, including small sample size, retrospective design and presence of confounders. Thus, some recommendations are based on low or very-low certainty of evidence. Importantly, these recommendations should be continually updated to reflect emerging evidence from clinical studies and real-world experience.
管理多重耐药菌感染患者具有挑战性，需要采取多学科方法来实现成功的临床结果。本文旨在提供这些感染的诊断和最佳管理建议，重点是靶向抗生素治疗。该文件由五个认可的意大利协会提名的专家小组制定，即意大利临床微生物学家协会（AMCLI）、意大利抗菌药物管理集团（GISA）、意大利微生物学会（SIM）、意大利传染病与热带病学会（SIMIT）和意大利抗感染治疗学会（SITA）。针对以下病原体，提出了关于微生物学诊断、药理学策略和靶向抗生素治疗的人群、干预、比较和结局（PICO）问题：耐碳青霉烯类肠杆菌科细菌；耐碳青霉烯类铜绿假单胞菌；耐碳青霉烯类鲍曼不动杆菌；以及耐甲氧西林金黄色葡萄球菌。根据 PICO 策略，对 2011 年 1 月至 2020 年 11 月发表的文献进行了系统综述。由于预计随机对照试验（RCT）的数据有限，也对观察性研究进行了审查。使用 GRADE 方法对证据的确定性进行分类。建议分为强或有条件。为每个病原体制定了详细的建议。大多数可用的 RCT 都存在严重的偏倚风险，许多观察性研究存在几个局限性，包括样本量小、回顾性设计和混杂因素的存在。因此，一些建议的证据确定性为低或极低。重要的是，这些建议应不断更新，以反映来自临床研究和真实世界经验的新证据。
