Multidrug-resistant bacteria in hematology patients: emerging threats.
Multidrug-resistant bacteria in hematology patients: emerging threats.
复制标题
血液病患者中的多重耐药细菌：新出现的威胁。
作者：
P. Tatarelli;M. Mikulska
多重耐药（MDR）细菌，特别是革兰氏阴性菌，如对第三代头孢菌素或碳青霉烯类耐药的肠杆菌科和MDR铜绿假单胞菌，在血液病患者中越来越常见。不同中心之间不同耐药物种的患病率差异显着。因此，当地流行病学的知识是强制性的，以决定最合适的管理协议。在抗生素耐药性日益增加的时代，经验性治疗发热性中性粒细胞减少症应个体化。在耐药菌株感染高风险患者出现重度临床表现的情况下，建议采用降级方法。革兰氏阴性耐药菌的靶向治疗通常需要联合治疗，尽管在这种情况下不存在大型随机试验。感染控制措施是限制血液科MDR病原体传播的基石。
Multidrug-resistant (MDR) bacteria, particularly Gram negatives, such as Enterobacteriaceae resistant to third-generation cephalosporins or carbapenems and MDR Pseudomonas aeruginosa, are increasingly frequent in hematology patients. The prevalence of different resistant species varies significantly between centers. Thus, the knowledge of local epidemiology is mandatory for deciding the most appr-opriate management protocols. In the era of increasing antibiotic resistance, empirical therapy of febrile neutropenia should be individualized. A de-escalation approach is recommended in case of severe clinical presentation in patients who are at high risk for infection with a resistant strain. Targeted therapy of an MDR Gram negative usually calls for a combination treatment, although no large randomized trials exist in this setting. Infection control measures are the cornerstone of limiting the spread of MDR pathogens in hematology units.
DOI：
10.1056/nejmoa1113849
发表时间：
2013-02-07
期刊：
The New England journal of medicine
影响因子：
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作者：
Climo MW;Yokoe DS;Warren DK;Perl TM;Bolon M;Herwaldt LA;Weinstein RA;Sepkowitz KA;Jernigan JA;Sanogo K;Wong ES
通讯作者：
Wong ES