Almyroudi Maria Panagiota, Chang Aina, Andrianopoulos Ioannis, Papathanakos Georgios, Mehta Reena, Paramythiotou Elizabeth, Koulenti Despoina
Emergency Department, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
Antibiotics (Basel). 2024 Jul 5;13(7):629. doi: 10.3390/antibiotics13070629.
Nosocomial pneumonia, including hospital-acquired pneumonia and ventilator-associated pneumonia, is the leading cause of death related to hospital-acquired infections among critically ill patients. A growing proportion of these cases are attributed to multi-drug-resistant (MDR-) Gram-negative bacteria (GNB). MDR-GNB pneumonia often leads to delayed appropriate treatment, prolonged hospital stays, and increased morbidity and mortality. This issue is compounded by the increased toxicity profiles of the conventional antibiotics required to treat MDR-GNB infections. In recent years, several novel antibiotics have been licensed for the treatment of GNB nosocomial pneumonia. These novel antibiotics are promising therapeutic options for treatment of nosocomial pneumonia by MDR pathogens with certain mechanisms of resistance. Still, antibiotic resistance remains an evolving global crisis, and resistance to novel antibiotics has started emerging, making their judicious use crucial to prolong their shelf-life. This article presents an up-to-date review of these novel antibiotics and their current role in the antimicrobial armamentarium. We critically present data for the pharmacokinetics/pharmacodynamics, the in vitro spectrum of antimicrobial activity and resistance, and in vivo data for their clinical and microbiological efficacy in trials. Where possible, available data are summarized specifically in patients with nosocomial pneumonia, as this cohort may exhibit 'critical illness' physiology that affects drug efficacy.
医院获得性肺炎，包括医院获得性肺炎和呼吸机相关性肺炎，是重症患者中与医院获得性感染相关的主要死亡原因。这些病例中越来越大的比例归因于多重耐药（MDR）革兰氏阴性菌（GNB）。MDR - GNB肺炎常导致适当治疗延迟、住院时间延长以及发病率和死亡率增加。治疗MDR - GNB感染所需的传统抗生素毒性增加，使这一问题更加复杂。近年来，几种新型抗生素已获许可用于治疗GNB医院获得性肺炎。这些新型抗生素对于治疗具有某些耐药机制的MDR病原体引起的医院获得性肺炎是有前景的治疗选择。然而，抗生素耐药性仍然是一个不断演变的全球危机，对新型抗生素的耐药性已经开始出现，明智地使用它们对于延长其有效期至关重要。本文对这些新型抗生素及其在抗菌药物库中的当前作用进行了最新综述。我们批判性地展示了其药代动力学/药效学数据、体外抗菌活性和耐药谱数据，以及它们在试验中的临床和微生物学疗效的体内数据。在可能的情况下，将现有数据专门总结在医院获得性肺炎患者中，因为这一群体可能表现出影响药物疗效的“危重病”生理学特征。
