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管理多重耐药菌:当前证据与知识空白

Managing Multidrug-Resistant spp.: current evidence and knowledge gaps.

作者信息

Geremia Nicholas, Di Bella Stefano

机构信息

Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale "dell'Angelo", Venice, Italy.

Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile "S.S. Giovanni e Paolo", Venice, Italy.

出版信息

Infez Med. 2025 Sep 1;33(3):261-267. doi: 10.53854/liim-3303-2. eCollection 2025.

DOI:10.53854/liim-3303-2
PMID:40933215
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12419164/
Abstract

species are emerging Gram-negative non-fermenting pathogens increasingly associated with human infections, particularly in patients with cystic fibrosis, immunocompromised hosts, and critically ill individuals. These bacteria exhibit intrinsic multi-drug resistance (MDR), complicating treatment and management. A comprehensive literature search was conducted to identify relevant studies concerning infections on PubMed/MEDLINE/Google Scholar and books written by experts in microbiology and infectious diseases. isolates frequently demonstrate resistance to the most common antimicrobials, such as β-lactams, aminoglycosides, fluoroquinolones, and polymyxins. Interestingly, many strains retain susceptibility to imipenem (IMP) despite resistance to meropenem due to the production of specific oxacillinase-type β-lactamases (OXA) called OXA-1152. Although robust clinical data are lacking, IMP and trimethoprim-sulfamethoxazole (SXT) are the most active agents and may be considered for empirical or combination therapy. Data on the efficacy of newer antibiotics against spp. are extremely limited and often inconsistent. This lack of strong evidence highlights a significant knowledge gap. A few antibiotic options are appropriate for treating spp. with IMP and SXT, which remains the treatment of choice, as well as in combination in the case of severe infections. This review focuses on a niche topic to support clinicians in selecting appropriate therapeutic decisions without precise evidence-based medicine.

摘要

某些菌种是新兴的革兰氏阴性非发酵病原体,越来越多地与人类感染相关,尤其是在囊性纤维化患者、免疫功能低下宿主和重症患者中。这些细菌表现出固有的多重耐药性(MDR),使治疗和管理变得复杂。进行了全面的文献检索,以在PubMed/MEDLINE/Google Scholar上识别有关感染的相关研究以及微生物学和传染病专家撰写的书籍。某些分离株经常对最常见的抗菌药物表现出耐药性,如β-内酰胺类、氨基糖苷类、氟喹诺酮类和多粘菌素类。有趣的是,由于产生了一种名为OXA-1152的特定奥沙西林酶型β-内酰胺酶(OXA),许多菌株尽管对美罗培南耐药,但对亚胺培南(IMP)仍保持敏感。尽管缺乏有力的临床数据,但IMP和甲氧苄啶-磺胺甲恶唑(SXT)是最有效的药物,可考虑用于经验性治疗或联合治疗。关于新型抗生素对某些菌种疗效的数据极其有限且往往不一致。这种缺乏有力证据的情况凸显了一个重大的知识空白。少数抗生素选择适用于治疗某些菌种,其中IMP和SXT仍然是治疗的首选,在严重感染的情况下也可联合使用。本综述聚焦于一个小众话题,以支持临床医生在没有精确循证医学依据的情况下做出适当的治疗决策。