Management of multidrug-resistant enterococcal infections.
Management of multidrug-resistant enterococcal infections.
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DOI：
10.1111/j.1469-0691.2010.03214.x
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Murray BE
中科院分区：
文献类型：
--
作者：
Arias CA;Contreras GA;Murray BE
肠球菌是具有显著的适应环境和获得抗生素耐药性决定因素的能力的生物体。这些微生物中抗菌素耐药性的演变给临床医生在面对严重感染患者时带来了巨大的挑战。耐多药屎肠球菌在全球范围内的流行和传播的增加导致了治疗选择的大幅减少，因为大多数的屎肠球菌。屎肠菌分离株现在对氨苄青霉素和万古霉素具有抗性，并且对氨基糖苷类抗生素（三种传统上最有用的抗肠球菌抗生素）具有高水平的抗性。较新的抗生素如利奈唑胺、达托霉素和替加环素对肠球菌分离株具有良好的体外活性，尽管它们的临床使用在某些临床情况下可能受到限制，这分别是由于成功率降低、肠球菌可能剂量不足和血清水平低以及出现耐药性。实验性药物奥利万星可能为治疗万古霉素耐药肠球菌提供一些希望，但仍缺乏临床数据。因此，治疗多重耐药肠球菌感染的最佳疗法仍然是基于经验观察和体外和动物数据的外推。临床研究评价新的策略，包括联合治疗，以治疗严重的万古霉素耐药大肠杆菌。粪便感染是迫切需要的。
Enterococci are organisms with a remarkable ability to adapt to the environment and acquire antibiotic resistance determinants. The evolution of antimicrobial resistance in these organisms poses enormous challenges for clinicians when faced with patients affected with severe infections. The increased prevalence and dissemination of multidrug-resistant Enterococcus faecium worldwide has resulted in a major decrease in therapeutic options because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin, and exhibit high-level resistance to aminoglycosides, which are three of the traditionally most useful anti-enterococcal antibiotics. Newer antibiotics such as linezolid, daptomycin and tigecycline have good in vitro activity against enterococcal isolates, although their clinical use may be limited in certain clinical scenarios as a result of reduced rates of success, possible underdosing for enterococci and low serum levels, respectively, and also by the emergence of resistance. The experimental agent oritavancin may offer some hope for the treatment of vancomycin-resistant enterococci but clinical data are still lacking. Thus, optimal therapies for the treatment of multidrug-resistant enterococcal infections continue to be based on empirical observations and extrapolations from in vitro and animal data. Clinical studies evaluating new strategies, including combination therapies, to treat severe vancomycin-resistant E. faecium infections are urgently needed.
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影响因子：
9.4
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