Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neuroscience.
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Curr Opin Crit Care. 2023 Oct 1;29(5):438-445. doi: 10.1097/MCC.0000000000001074. Epub 2023 Jul 31.
Antimicrobial resistance (AMR) in Gram-negative bacteria (GNB) poses a significant global health concern, contributing to increased infections, mortality rates, and healthcare costs. This review discusses the main clinical manifestations, therapeutic options, and recent findings in managing antibiotic-resistant GNB, with a focus on difficult-to-treat infections.
Difficult-to-treat resistance (DTR) is a novel classification that identifies GNB exhibiting intermediate or resistant phenotypes to first-line agents in the carbapenem, beta-lactam, and fluoroquinolone categories. The main pathogens implicated in severe infections include DTR Enterobacterales, DTR Pseudomonas aeruginosa , and DTR Acinetobacter baumannii. Although the clinical implications of DTR strains are still under investigation, certain studies have linked them to prolonged hospital stays and poor patient outcomes.
Severe infections caused by DTR-GNB pose a formidable challenge for healthcare providers and represent a growing global health issue. The proper administration and optimization of novel antibiotics at our disposal are of paramount importance for combating bacterial resistance and improving patient prognosis.
革兰氏阴性菌(GNB)的抗生素耐药性(AMR)是一个重大的全球健康问题,导致感染增加、死亡率上升和医疗保健费用增加。本文讨论了管理抗生素耐药性 GNB 的主要临床表现、治疗选择和最新发现,重点是治疗困难的感染。
难处理的耐药性(DTR)是一种新的分类,它确定了对碳青霉烯类、β-内酰胺类和氟喹诺酮类一线药物表现出中介或耐药表型的 GNB。严重感染涉及的主要病原体包括 DTR 肠杆菌科、DTR 铜绿假单胞菌和 DTR 鲍曼不动杆菌。虽然 DTR 菌株的临床意义仍在研究中,但一些研究表明它们与延长住院时间和患者预后不良有关。
由 DTR-GNB 引起的严重感染对医疗保健提供者构成了巨大挑战,是一个日益严重的全球健康问题。正确管理和优化我们现有的新型抗生素对于对抗细菌耐药性和改善患者预后至关重要。