Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China.
Expert Rev Anti Infect Ther. 2023 Jul-Dec;21(11):1203-1212. doi: 10.1080/14787210.2023.2267765. Epub 2023 Nov 8.
Difficult-to-treat resistance (DTR) is a newly proposed resistance phenotype characterized by resistance to all first-line drugs. The emergence of DTR as a new resistance phenotype has significant implications for clinical practice. This new concept has the potential to be widely used instead of traditional phenotypes.
This study carried out a detailed analysis about the definition, application, and evolution of various resistance phenotypes. We collected all the research articles on Gram-negative bacteria with difficult-to-treat resistance (GNB-DTR), analyzed the DTR in each region and each bacterial species. The advantages and doubts of DTR, the dilemma of GNB-DTR infections and the potential therapeutic strategies are summarized in the review.
Available studies show that the prevalence of GNB-DTR is not optimistic. Unlike traditional resistance phenotypes, DTR is more closely aligned with the clinical treatment perspective and can help with the prompt selection of an appropriate treatment plan. Currently, potential treatment options for GNB-DTR include a number of second-line drugs and novel antibiotics. However, the definition of first-line drugs is inherently dynamic. Therefore, the DTR concept based on first-line drugs needs to be continuously updated and refined, considering the emergence of new antibiotics, resistance characteristics, and pathogen prevalence in different regions.
难治疗性耐药（DTR）是一种新提出的耐药表型，其特征是对所有一线药物均耐药。DTR 作为一种新的耐药表型的出现对临床实践具有重要意义。这一新概念有可能被广泛应用，取代传统表型。
本研究对各种耐药表型的定义、应用和演变进行了详细分析。我们收集了所有关于难治疗性耐药（GNB-DTR）革兰氏阴性菌的研究文章，对每个地区和每个细菌物种的 DTR 进行了分析。在综述中总结了 DTR 的优点和疑虑、GNB-DTR 感染的困境以及潜在的治疗策略。
现有研究表明，GNB-DTR 的流行情况不容乐观。与传统耐药表型不同，DTR 更符合临床治疗视角，可以帮助及时选择合适的治疗方案。目前，GNB-DTR 的潜在治疗选择包括多种二线药物和新型抗生素。但是，一线药物的定义本质上是动态的。因此，基于一线药物的 DTR 概念需要不断更新和完善，考虑到新抗生素的出现、耐药特征以及不同地区病原体的流行情况。
