Perez Federico, El Chakhtoura Nadim G, Bonomo Robert A
Geriatrics Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs, Cleveland, OH, USA; Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA; CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (CARES), Case Western Reserve University, Cleveland, OH, USA.
Geriatrics Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs, Cleveland, OH, USA; CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (CARES), Case Western Reserve University, Cleveland, OH, USA.
Med Clin North Am. 2025 May;109(3):735-747. doi: 10.1016/j.mcna.2025.01.003. Epub 2025 Feb 28.
This article provides an overview of the mechanisms behind carbapenem resistance and the antibiotic management for severe infections caused by key carbapenem-resistant gram-negative bacteria, specifically Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa. For Enterobacterales, it highlights the relative advantages of meropenem-vaborbactam and imipenem-relebactam in treating Klebsiella pneumoniae carbapenemase (KPC)-producing strains with resistance to ceftazidime-avibactam, the preference for ceftazidime-avibactam in addressing oxacillin-hydrolyzing carpapenemase (OXA)-48-like -producing organisms, and the combination of ceftazidime-avibactam with aztreonam for metallo-β-lactamase (MBL)-producing Enterobacterales. Regarding A baumannii, sulbactam-durlobactam is identified as the preferred treatment, while ceftolozane-tazobactam, ceftazidime-avibactam, and imipenem-relebactam are viable options for P aeruginosa. Additionally, cefiderocol is presented as an alternative for MBL-producing carbapenem-resistant gram-negative bacteria.
本文概述了碳青霉烯类耐药背后的机制以及针对由关键耐碳青霉烯类革兰氏阴性菌，特别是肠杆菌科细菌、鲍曼不动杆菌和铜绿假单胞菌引起的严重感染的抗生素管理。对于肠杆菌科细菌，它强调了美罗培南-巴坦和亚胺培南-瑞巴坦在治疗对头孢他啶-阿维巴坦耐药的产肺炎克雷伯菌碳青霉烯酶（KPC）菌株方面的相对优势，在应对产水解碳青霉烯酶（OXA）-48样酶的生物体时对头孢他啶-阿维巴坦的偏好，以及头孢他啶-阿维巴坦与氨曲南联合用于产金属β-内酰胺酶（MBL）的肠杆菌科细菌。关于鲍曼不动杆菌，舒巴坦-杜洛巴坦被确定为首选治疗药物；而对于铜绿假单胞菌，头孢洛扎坦-他唑巴坦、头孢他啶-阿维巴坦和亚胺培南-瑞巴坦是可行的选择。此外，头孢地尔被提出作为产MBL的耐碳青霉烯类革兰氏阴性菌的替代药物。
