The Global Challenge of Carbapenem-Resistant Enterobacteriaceae in Transplant Recipients and Patients With Hematologic Malignancies
The Global Challenge of Carbapenem-Resistant Enterobacteriaceae in Transplant Recipients and Patients With Hematologic Malignancies
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DOI：
10.1093/cid/ciu052
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发表时间：
2014-05-01
影响因子：
11.8
通讯作者：
Walsh, Thomas J.
中科院分区：
文献类型：
--
作者：
Satlin, Michael J.;Jenkins, Stephen G.;Walsh, Thomas J.
耐碳青霉烯类肠杆菌科（CRE）是全球新兴的病原体。CRE向移植受者和恶性血液病患者的传播具有不祥的意义。这些患者依赖于及时、积极的抗菌治疗来对抗革兰氏阴性菌感染;然而，推荐的经验性方案对CRE无效。在CRE流行地区，大约3%-10%的实体器官移植（SOT）受者发生CRE感染，感染部位与移植器官相关。与CRE感染相关的死亡率在SOT接受者中接近40%，在恶性血液病患者中接近65%。鉴于目前用于对抗CRE的抗微生物药物极其有限，需要采取多方面的方法，包括抗微生物管理和积极监测，以预防免疫功能低下宿主的CRE感染。改善已确定感染的结果将需要使用基于风险因素的预测工具和分子测定，以更快地实施CRE活性治疗，并开发具有抗CRE活性的新抗菌药物。
Carbapenem-resistant Enterobacteriaceae (CRE) are emerging global pathogens. The spread of CRE to transplant recipients and patients with hematologic malignancies has ominous implications. These patients rely on timely, active antibacterial therapy to combat gram-negative infections; however, recommended empirical regimens are not active against CRE. Approximately 3%-10% of solid organ transplant (SOT) recipients in CRE-endemic areas develop CRE infection, and the infection site correlates with the transplanted organ. Mortality rates associated with CRE infections approach 40% in SOT recipients and 65% in patients with hematologic malignancies. Given that the current antimicrobial armamentarium to combat CRE is extremely limited, a multifaceted approach that includes antimicrobial stewardship and active surveillance is needed to prevent CRE infections in immunocompromised hosts. Improving outcomes of established infections will require the use of risk factor-based prediction tools and molecular assays to more rapidly administer CRE-active therapy and the development of new antimicrobial agents with activity against CRE.