在重症患者中治疗MDR/XDR严重感染
Luca Mezzadri1,2, Ya-Ting Chang1,3, David L Paterson1,4
1ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Current opinion in critical care
|September 5, 2025
概括
应对多药耐药 (MDR) 和广泛耐药 (XDR) 病原体的严重感染需要对治疗方法和耐药性的最新知识. 高质量的临床试验对于基于证据的治疗这些具有挑战性的感染至关重要.
科学领域:
- 传染性疾病
- 临床微生物学
- 药理学
背景情况:
- 由多抗药性 (MDR) 和广泛抗药性 (XDR) 病原体引起的严重感染构成了全球重大健康挑战.
- 目前的治疗指南往往由于缺乏对这些难以治疗的生物体的可靠临床试验数据而受到限制.
研究的目的:
- 审查目前对MDR/XDR病原体引起的严重感染的管理建议.
- 专注于随机对照试验 (RCT) 的证据,并强调新出现的治疗方案.
主要方法:
- 随机对照试验 (RCT) 和最新临床数据的系统审查.
- 对特定MDR/XDR病原体的治疗策略的分析,包括Gram阳性和Gram阴性细菌.
主要成果:
- 对于抗甲基素黄金葡萄球菌 (MRSA) 血流感染 (BSI),范素,线素和达普素是主要的选择,而 ceftobiprole 是一种较新的药物.
- 对抗万科米辛的Enterococcus faeciumBSI的治疗依赖于线索利德和达普米辛.
- 治疗MDR/XDR阴性菌感染具有挑战性;新的β- 乳酸/β- 乳酸酶抑制剂组合对抗卡巴耐药 Enterobacterales 和 Pseudomonas aeruginosa 具有关键作用.
- 对于金属β-乳糖酶生产者来说,Cefiderocol和ceftazidime-avibactam加上aztreonam是最后的选择.
- 苏尔巴克坦 - 杜尔巴克坦对抗卡巴耐药的Acinetobacter baumannii具有前景,但其可用性有限.
结论:
- 有效管理严重的MDR/XDR感染需要不断更新治疗选择和耐药性模式.
- 需要更多高质量的临床试验来建立基于证据的治疗指南.
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