PRO: Testing for ESBL production is necessary for ceftriaxone-non-susceptible Enterobacterales: perfect should not be the enemy of progress.
PRO: Testing for ESBL production is necessary for ceftriaxone-non-susceptible Enterobacterales: perfect should not be the enemy of progress.
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DOI：
10.1093/jacamr/dlab019
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发表时间：
2021-06
影响因子：
3.4
通讯作者：
Humphries RM
中科院分区：
文献类型：
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作者：
Tamma PD;Humphries RM
MERINO试验似乎解决了这个问题：“碳青霉烯类是ESBL产生感染的首选治疗方法吗？”然而，它把另一个重要的问题带到了最前沿：“我们如何知道我们什么时候有产ESBL的感染？”一种常用的方法是解释对第三代头孢菌素的不敏感性（例如，头孢曲松MIC ≥ 2 mg/L）是ESBL产生的准确指标。我们认为，仅仅依靠抗生素敏感性结果来预测临床分离株中ESBL的产生充满了问题。相反，我们认为，检测全面范围的ESBL基因以及其他相关β-内酰胺酶基因的准确分子检测在现有技术的范围内，并且是优化患者护理所必需的。在此，我们详细说明了为什么目前用于确定生物体是否可能是ESBL生产者的方法（i）是不准确的;（ii）鼓励碳青霉烯类药物过度使用;（iii）忽视了其他Enterococcales物种中ESBL生产的潜力;（iv）促进ESBL传播的沉默流行。
The MERINO trial has seemingly laid to rest the question: ‘Are carbapenems the preferred therapy for ESBL-producing infections?’ It has, however, brought another important question to the forefront: ‘How do we know when we have an ESBL-producing infection?’ A commonly used approach is the interpretation that non-susceptibility to third-generation cephalosporins (e.g. ceftriaxone MICs of ≥2 mg/L) is an accurate proxy for ESBL production. We believe that relying on antibiotic susceptibility results alone to predict ESBL production in clinical isolates is fraught with issues. Rather, we believe accurate molecular assays that detect a comprehensive range of ESBL genes, along with other relevant β-lactamase genes, are well within the reach of existing technology and necessary to optimize patient care. Herein, we elaborate on why the current approach for determining whether an organism is likely to be an ESBL producer (i) is inaccurate; (ii) encourages carbapenem overuse; (iii) ignores the potential for ESBL production in other Enterobacterales species; and (iv) promotes the silent epidemic of ESBL transmission.