Aslan Abdullah Tarık, Akova Murat
Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Hacettepe University, Ankara, Türkiye.
Expert Rev Anti Infect Ther. 2024 Dec;22(12):1055-1071. doi: 10.1080/14787210.2024.2408746. Epub 2024 Sep 29.
Patients with hematological malignancies (PHMs) are at increased risk for infections caused by carbapenem-resistant organisms (CROs) due to frequent exposure to broad-spectrum antibiotics and prolonged hospital stays. These infections result in high mortality and morbidity rates along with delays in chemotherapy, longer hospitalizations, and increased health care costs.
Treatment alternatives for CRO infections in PHMs.
The best available treatment option for KPC and OXA-48 producers is ceftazidime/avibactam. Imipenem/cilastatin/relebactam and meropenem/vaborbactam remain as the alternative options. They can also be used as salvage therapy in KPC-positive infections resistant to ceftazidime/avibactam, if susceptibility is shown. Treatment of metallo-β-lactamase producers is an unmet need. Ceftazidime/avibactam plus aztreonam or aztreonam/avibactam seems to be the most reliable option for metallo-β-lactamase producers. As a first-line option for carbapenem-resistant infections, ceftolozane/tazobactam is preferable and ceftazidime/avibactam and imipenem/cilastatin/relebactam constitute alternative regimens. Although sulbactam/durlobactam is the most reliable option against carbapenem-resistant infections, its utility as monotherapy and in PHMs is not yet known. Cefiderocol can be selected as a 'last-resort' option for CRO infections. New risk score models supported by artificial intelligence algorithms can be used to predict the exact risk of infections in previously colonized patients.
血液系统恶性肿瘤患者（PHMs）由于频繁接触广谱抗生素和住院时间延长，感染耐碳青霉烯类微生物（CROs）的风险增加。这些感染导致高死亡率和发病率，同时化疗延迟、住院时间延长以及医疗保健成本增加。
PHMs中CRO感染的治疗替代方案。
对于产KPC和OXA-48的菌株，最佳可用治疗选择是头孢他啶/阿维巴坦。亚胺培南/西司他丁/雷利巴坦和美罗培南/万巴巴坦仍是替代选择。如果显示敏感，它们也可用于对头孢他啶/阿维巴坦耐药的KPC阳性感染的挽救治疗。治疗产金属β-内酰胺酶的菌株是一项未满足的需求。头孢他啶/阿维巴坦加氨曲南或氨曲南/阿维巴坦似乎是治疗产金属β-内酰胺酶菌株最可靠的选择。作为耐碳青霉烯类感染的一线选择，头孢洛扎/他唑巴坦更可取，头孢他啶/阿维巴坦和亚胺培南/西司他丁/雷利巴坦构成替代方案。尽管舒巴坦/杜洛巴坦是对抗耐碳青霉烯类感染最可靠的选择，但其作为单药治疗以及在PHMs中的效用尚不清楚。头孢地尔可作为CRO感染的“最后手段”选择。由人工智能算法支持的新风险评分模型可用于预测先前定植患者的确切感染风险。
