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临床挑战:儿童美罗培南标准输注与延长输注对比

Clinical Challenge: Standard Versus Extended Meropenem Infusion in Children.

作者信息

Kişi Ahmet Erhan, Aykaç Kübra, Özsurekci Yasemin

机构信息

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.

出版信息

Turk Arch Pediatr. 2024 Mar 7;59(3):238-242. doi: 10.5152/TurkArchPediatr.2024.23245.

Abstract

The management of Gram-negative bacterial infections poses a significant challenge due to the emergence of highly effective antibiotic-resistant mechanisms, leading to treatment failures, particularly among hospitalized children. This patient population experiences elevated rates of both mortality and morbidity, and the available antibiotic options against these bacteria are limited. Carbapenems, such as meropenem, represent one of the choices for treatment. While meropenem is highly effective against Gram-negative bacteria, the prevalence of multidrug-resistant infections in hospitals has become a growing concern. In response to this challenge, exploring innovative strategies is crucial. One such strategy is the implementation of high-dose extended meropenem infusion treatment. Researchers propose that extended meropenem treatment may offer a viable solution to combat resistant bacteria. Despite a limited number of studies focusing on the effectiveness of this strategy in children, our comprehensive review of the literature revealed promising findings. Our examination specifically compared extended infusion with standard infusion approaches. The evidence suggests that extended infusion of meropenem provides more benefits compared to standard infusion methods. Researchers consistently reported positive results in their observations, with the exception noted in very low birth weight neonates and children with infections caused by carbapenem-resistant Enterobacteria and Acinetobacter baumannii spp. In conclusion, extended meropenem infusion treatment emerges as a promising option for managing resistant infections. However, it is essential to underscore the need for further studies to robustly support the observed benefits of this treatment regimen.

摘要

由于高效抗生素耐药机制的出现,革兰氏阴性菌感染的管理面临重大挑战,导致治疗失败,尤其是在住院儿童中。这一患者群体的死亡率和发病率都有所上升,而且针对这些细菌的可用抗生素选择有限。碳青霉烯类药物,如美罗培南,是治疗选择之一。虽然美罗培南对革兰氏阴性菌非常有效,但医院中多重耐药感染的流行已成为一个日益严重的问题。为应对这一挑战,探索创新策略至关重要。一种这样的策略是实施高剂量延长美罗培南输注治疗。研究人员提出,延长美罗培南治疗可能为对抗耐药细菌提供一个可行的解决方案。尽管关注该策略在儿童中有效性的研究数量有限,但我们对文献的全面综述揭示了有前景的发现。我们的研究特别比较了延长输注与标准输注方法。证据表明,与标准输注方法相比,美罗培南延长输注带来的益处更多。研究人员在观察中一致报告了积极结果,但极低出生体重新生儿以及由耐碳青霉烯肠杆菌和鲍曼不动杆菌属引起感染的儿童除外。总之,美罗培南延长输注治疗成为管理耐药感染的一个有前景的选择。然而,必须强调需要进一步研究以有力支持该治疗方案所观察到的益处。

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