Extended-spectrum β-lactamases and clinical outcomes:: Current data
Extended-spectrum β-lactamases and clinical outcomes:: Current data
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DOI：
10.1086/500663
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发表时间：
2006-04-15
影响因子：
11.8
通讯作者：
Ambrose, PG
中科院分区：
文献类型：
--
作者：
Ramphal, R;Ambrose, PG
由广谱β -内酰胺酶（ESBL）产生的革兰氏阴性菌引起的医院感染使治疗复杂化并限制了治疗选择。然而，由产生ESBL的细菌引起的感染的临床意义尚不清楚。对文献的批判性审查提供了关于ESBL携带对发病率和死亡率影响的不同观点，并表明ESBL生产可能对头孢他啶的影响最为显著。对于由产生ESBL的病原体引起的感染，经经验和定向治疗的有效策略包括使用碳青霉烯类，可能还有第四代头孢菌素头孢吡肟。研究表明，使用头孢吡肟治疗严重的医院感染（如菌血症、肺炎和尿路感染）与微生物学和临床成功率高相关。对于具有ESBL表型的大肠埃希菌和肺炎克雷伯菌，头孢吡肟比其他抗菌剂达到最低抑菌浓度目标（至少为给药间隔的70%）的概率更高，这是临床成功的重要药效学指标。而对于非产esbl的菌株，头孢他啶和头孢吡肟在最小抑菌浓度以上的时间上没有差异。当在机构环境中适当使用时，头孢吡肟减少了头孢菌素的总体使用，从而减少了可能产生ESBL的病原体的选择压力。
Nosocomial infections caused by extended-spectrum beta-lactamase (ESBL)-producing gram- negative bacteria complicate therapy and limit treatment options. However, the clinical significance of infections caused by ESBL- producing bacteria remains unclear. A critical examination of the literature provides divergent views of the effect of ESBL carriage on morbidity and mortality and suggests that ESBL production may have its most marked effect on ceftazidime. Effective strategies for the empirical and directed treatment of infections caused by ESBL- producing pathogens include the use of carbapenems and, possibly, the fourth-generation cephalosporin cefepime. Studies indicate that the use of cefepime to treat serious nosocomial infections ( e. g., bacteremia, pneumonia, and urinary tract infections) is associated with high rates of microbiological and clinical success. The probability of attaining time above the minimum inhibitory concentration targets of at least 70% of the dosing interval, an important pharmacodynamic indicator of clinical success, is higher with cefepime than with other antimicrobials against Escherichia coli and Klebsiella pneumoniae strains exhibiting ESBL phenotypes. However, for non-ESBL-producing strains, there is no difference in the time above the minimum inhibitory concentration between ceftazidime and cefepime. When used appropriately in institutional settings, cefepime reduces the overall use of cephalosporins, thereby decreasing selection pressure for presumptive ESBL- producing pathogens.