Carbonell Nieves, Oltra María Rosa, Clari María Ángeles
Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
Infectious Disease Unit, Internal Medicine Department, Clinic University Hospital, INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
Antibiotics (Basel). 2024 Jun 22;13(7):577. doi: 10.3390/antibiotics13070577.
The aim of this review is to synthesise the key aspects of the epidemiology, current microbiological diagnostic challenges, antibiotic resistance rates, optimal antimicrobial management, and most effective prevention strategies for (SM) in the intensive care unit (ICU) population. In recent years, resistance surveillance data indicate that SM accounts for less than 3% of all healthcare-associated infection strains, a percentage that doubles in the case of ventilator-associated pneumonia (VAP). Interestingly, SM ranks as the third most isolated non-glucose fermenter Gram-negative bacilli (NFGNB). Although this NFGNB genus has usually been considered a bystander and colonising strain, recently published data warn about its potential role as a causative pathogen of severe infections, particularly pneumonia and bloodstream infections (BSI), not only for the classical immunocompromised susceptible host patients but also for critically ill ones even without overt immunosuppression. Indeed, it has been associated with crude 28-day mortality as high as 54.8%, despite initial response following targeted therapy. Additionally, alongside its intrinsic resistance to a wide range of common antimicrobials, various worldwide and local surveillance studies raise concerns about an increase in ICU settings regarding resistance to first-line drugs such as cotrimoxazole or tigecycline. This scenario alerts ICU physicians to the need to reconsider the best stewardship approach when SM is isolated in obtained samples from critically ill patients. Despite the coverage of this multidrug-resistant bacterium (MDRB) provided by some traditional and a non-negligible number of current pipeline antimicrobials, an ecological and cost-effective strategy is needed in the present era.
本综述的目的是综合重症监护病房（ICU）人群中嗜麦芽窄食单胞菌（SM）的流行病学关键方面、当前微生物诊断挑战、抗生素耐药率、最佳抗菌管理以及最有效的预防策略。近年来，耐药监测数据表明，SM在所有医疗保健相关感染菌株中所占比例不到3%，在呼吸机相关性肺炎（VAP）病例中这一比例会翻倍。有趣的是，SM是第三大最常分离出的非葡萄糖发酵革兰氏阴性杆菌（NFGNB）。尽管这种NFGNB属通常被认为是旁观者和定植菌株，但最近发表的数据警示了其作为严重感染病原体的潜在作用，尤其是肺炎和血流感染（BSI），不仅在典型的免疫受损易感宿主患者中如此，在即使没有明显免疫抑制的重症患者中也是如此。事实上，尽管经过靶向治疗后有初始反应，但它仍与高达54.8%的28天粗死亡率相关。此外，除了其对多种常见抗菌药物的固有耐药性外，全球和本地的各种监测研究都对ICU环境中对一线药物如复方新诺明或替加环素的耐药性增加表示担忧。这种情况提醒ICU医生，当从重症患者的样本中分离出SM时，需要重新考虑最佳的管理方法。尽管一些传统抗菌药物以及数量可观的现有在研抗菌药物对这种多重耐药菌（MDRB）有覆盖作用，但在当今时代仍需要一种生态且具有成本效益的策略。
