Division of Infectious Diseases, American University of Beirut Medical Center, Beirut , Lebanon.
Curr Opin Infect Dis. 2022 Dec 1;35(6):614-620. doi: 10.1097/QCO.0000000000000861. Epub 2022 Aug 3.
Antimicrobial overuse is a major health problem that contributes to antimicrobial resistance (AMR). Infections with Gram-negative bacilli (GNB) and multidrug-resistant organisms (MDRs) are associated with high morbidity and mortality, particularly in patients with underlying medical conditions.
Although many recent studies have been published about the novel antibiotics in treating infections including those due to MDR-GNB, the optimal duration of treatment (DOT) remains inconclusive. Recent observation has supported that short antibiotic therapy (SAT) decreases AMR and adverse effects. This narrative review provides an overview of the most recent published studies on the duration of therapy in the treatment of GNB infections, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), intra-abdominal infections (IAIs), bloodstream infections (BSIs) and urinary tract infections (UTIs), with a particular focus on MDR-GNB.
Studies showed different outcomes when comparing SAT to long antimicrobial therapy (LAT). No generalization can be made on all sites of infections and different GNBs. Further studies are needed to address the optimal DOT in MDR-GNB, as this group is underrepresented in recent studies.
目的综述：抗菌药物过度使用是一个主要的健康问题，会导致抗菌药物耐药性（AMR）。革兰氏阴性杆菌（GNB）和多重耐药菌（MDR）感染与高发病率和死亡率相关，特别是在有基础疾病的患者中。
最新发现：尽管最近发表了许多关于治疗包括 MDR-GNB 引起的感染的新型抗生素的研究，但治疗的最佳持续时间（DOT）仍不确定。最近的观察结果支持短程抗生素治疗（SAT）可降低 AMR 和不良反应。本综述概述了最近发表的关于 GNB 感染治疗持续时间的研究，包括医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）、腹腔内感染（IAI）、血流感染（BSI）和尿路感染（UTI），特别关注 MDR-GNB。
总结：研究表明 SAT 与长程抗菌治疗（LAT）相比，结果不同。不能对所有感染部位和不同的 GNB 一概而论。需要进一步的研究来确定 MDR-GNB 的最佳 DOT，因为这一组在最近的研究中代表性不足。
