Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
Curr Opin Infect Dis. 2024 Dec 1;37(6):594-601. doi: 10.1097/QCO.0000000000001044. Epub 2024 Sep 18.
To correlate the resistance mechanisms and the susceptibility to new antibiotics in Pseudomonas aeruginosa .
Definition of antibiotic resistance in Pseudomonas aeruginosa is still debated. Carbapenem-resistant Pseudomonas aeruginosa (CRPA) and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) are used but which of them better correlate with the risk of mortality remains debated. Mechanisms underlying resistance in Pseudomonas aeruginosa are complex and may be combined, resulting in unpredictable phenotype and cross-resistance. Thus, not all CRPA are alike and tailoring antibiotic therapy on resistance mechanisms is challenging.
Current guidelines recommend the use of new antipseudomonal agents for CRPA or DTR-PA infections but they don't provide specific information on how tailoring antibiotic therapy on underlying resistance mechanisms. This review may be useful to understand which mechanisms are involved in CRPA and may have practical implications helping clinicians to select an appropriate antibiotic regimen. Several antibiotics are now available for Pseudomonas aeruginosa but their rational use is important to avoid development of future resistance. The knowledge of local epidemiology and most common resistance mechanisms may guide empirical therapy, but targeted antibiotic therapy should be re-evaluated as soon as susceptibility testing profile is available and selected according to Pseudomonas aeruginosa phenotype.
探讨铜绿假单胞菌的耐药机制与新型抗生素敏感性的相关性。
铜绿假单胞菌的抗生素耐药定义仍存在争议。目前使用耐碳青霉烯铜绿假单胞菌（CRPA）和治疗困难的耐药铜绿假单胞菌（DTR-PA）来描述，但哪种更好地与死亡率风险相关仍存在争议。铜绿假单胞菌的耐药机制复杂且可能联合出现，导致表型不可预测和交叉耐药。因此，并非所有 CRPA 都相同，根据耐药机制定制抗生素治疗具有挑战性。
目前的指南建议对 CRPA 或 DTR-PA 感染使用新型抗假单胞菌药物，但并未就如何根据潜在耐药机制定制抗生素治疗提供具体信息。本文综述可能有助于了解 CRPA 涉及的机制，并可能具有实际意义，帮助临床医生选择合适的抗生素治疗方案。目前有几种抗生素可用于治疗铜绿假单胞菌，但合理使用抗生素很重要，以避免未来耐药性的产生。了解当地的流行病学和最常见的耐药机制有助于指导经验性治疗，但应在药敏试验结果可用时重新评估靶向抗生素治疗，并根据铜绿假单胞菌表型进行选择。
