Antimicrobial Treatment Options for Difficult-to-Treat Resistant Gram-Negative Bacteria Causing Cystitis, Pyelonephritis, and Prostatitis: A Narrative Review.
Antimicrobial Treatment Options for Difficult-to-Treat Resistant Gram-Negative Bacteria Causing Cystitis, Pyelonephritis, and Prostatitis: A Narrative Review.
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DOI：
10.1007/s40265-022-01676-5
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发表时间：
2022-03
期刊：
影响因子：
11.5
通讯作者：
Trautner, Barbara W.
中科院分区：
文献类型：
--
作者：
Chou, Andrew;Welch, Elwyn;Hunter, Andrew;Trautner, Barbara W.
尿路感染(UTI)，包括膀胱炎、急性肾盂肾炎和前列腺炎，是促使开抗生素处方的最常见的诊断之一。在过去的几十年里，由于革兰氏阴性细菌的多重耐药和“难以治疗的耐药性”(DTR)，抗生素耐药性的上升导致UTI面临越来越大的挑战。药物治疗和医学微生物学的最新进展正在使这些尿路感染的治疗方式现代化。药物治疗方面的进展不仅包括开发和批准新型抗生素，如头孢他啶/阿维巴坦、美罗培南/万宝巴坦、亚胺培南/瑞巴坦、头孢洛赞/他唑巴坦、头孢德罗、广场霉素和甘环素，还包括重新审查遗留抗生素的潜在作用，包括较老的氨基糖苷类和四环素类药物。医学微生物学的最新进展使耐药性检测的表型和分子机制成为可能，因此抗生素处方可以根据感染病原体的耐药性机制进行定制。在这里，我们对可用于DTR革兰氏阴性菌的药物的临床和临床前研究进行叙述性回顾，尤其是与尿路相关的数据。我们还根据微生物及其耐药机制，为遇到DTR-革兰氏阴性菌引起的尿路感染时抗生素的选择提供了一个实用的框架。
Urinary tract infections (UTI), including cystitis, acute pyelonephritis, and prostatitis, are among the most common diagnoses prompting antibiotic prescribing. The rise in antimicrobial resistance over the past decades has led to the increasing challenge of UTI due to multidrug resistant and “difficult-to-treat resistance” (DTR) among Gram-negative bacteria. Recent advances in pharmacotherapy and medical microbiology are modernizing how these UTIs are treated. Advances in pharmacotherapy have included not only the development and approval of novel antibiotics, such as ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, ceftolozane/tazobactam, cefiderocol, plazomicin, and glycylcyclines, but also the re-examination of the potential role of legacy antibiotics, including older aminoglycosides and tetracyclines. Recent advances in medical microbiology allow phenotypic and molecular mechanism of resistance testing, and so that antibiotic prescribing can be tailored to the mechanism of resistance in the infecting pathogen. Here, we provide a narrative review on the clinical and pre-clinical studies of drugs that can be used for DTR Gram-negative bacteria, with particular focus on data relevant to the urinary tract. We also offer a pragmatic framework for antibiotic selection when encountering UTI due to DTR Gram-negative bacteria based on the organism and its mechanism of resistance.
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