Contemporary Perspective on the Treatment of Acinetobacter baumannii Infections: Insights from the Society of Infectious Diseases Pharmacists.
Contemporary Perspective on the Treatment of Acinetobacter baumannii Infections: Insights from the Society of Infectious Diseases Pharmacists.
复制标题
DOI：
10.1007/s40121-021-00541-4
复制
发表时间：
2021-12
影响因子：
5.4
通讯作者：
Escobar ZK
中科院分区：
文献类型：
--
作者：
Abdul-Mutakabbir JC;Griffith NC;Shields RK;Tverdek FP;Escobar ZK
本叙述性综述的目的是汇集最新的流行病学、临床前和临床研究结果，以提供我们对管理鲍曼不动杆菌感染患者的最佳实践的观点，重点是碳青霉烯类耐药鲍曼不动杆菌（CRAB）。迄今为止，尚未确定CRAB感染的首选治疗方法。保留体外活性的传统药物（氨基糖苷类、多粘菌素类和四环素类）受到次优药代动力学特征、耐药性出现和/或毒性的限制。最近开发的和美国食品药品监督管理局（FDA）批准的β-内酰胺/β-内酰胺酶抑制剂不提供增强的抗CRAB活性。总的来说，头孢地罗可和埃拉环素显示出有效的体外活性，并且耐受性良好，但CRAB感染患者的临床数据尚未支持广泛使用。鉴于CRAB有能力感染易感患者，并且尚未确定首选方案，我们主张联合治疗。我们对感染或被认为具有CRAB高风险的危重患者的首选方案包括美罗培南、多粘菌素B和氨苄西林/舒巴坦。重要的是，感染部位、疾病严重程度和当地流行病学是选择联合治疗时需要考虑的重要因素。耐药的分子机制可能会揭示各个中心的首选组合;然而，这些数据通常无法提供给治疗临床医生，并且与改善的临床结局无关。联合策略也可能增加抗生素毒性和艰难梭菌感染的风险，因此应通过了解患者的护理目标和潜在的健康状况来平衡。正在临床开发和/或研究中的有前景的疗法包括durlobactam-舒巴坦、头孢地罗可联合方案和噬菌体疗法，随着时间的推移，这些疗法可能消除继续使用多粘菌素的需要。CRAB管理的未来目标包括以病原体为中心的治疗模式，这些模式基于耐药的分子机制、局部敏感率以及耐受性良好的有效治疗方案的可用性。
The purpose of this narrative review is to bring together the most recent epidemiologic, preclinical, and clinical findings to offer our perspective on best practices for managing patients with A. baumannii infections with an emphasis on carbapenem-resistant A. baumannii (CRAB). To date, the preferred treatment for CRAB infections has not been defined. Traditional agents with retained in vitro activity (aminoglycosides, polymyxins, and tetracyclines) are limited by suboptimal pharmacokinetic characteristics, emergence of resistance, and/or toxicity. Recently developed and US Food and Drug Administration (FDA)-approved β-lactam/β-lactamase inhibitor agents do not provide enhanced activity against CRAB. On balance, cefiderocol and eravacycline demonstrate potent in vitro activity and are well tolerated, but clinical data for patients with CRAB infections do not yet support widespread use. Given that CRAB has the capacity to infect vulnerable patients and preferred regimens have not been identified, we advocate for combination therapy. Our preferred regimen for critically ill patients infected, or considered to be at high risk for CRAB, includes meropenem, polymyxin B, and ampicillin/sulbactam. Importantly, site of infection, severity of illness, and local epidemiology are essential factors to be considered in selecting combination therapies. Molecular mechanisms of resistance may unveil preferred combinations at individual centers; however, such data are often unavailable to treating clinicians and have not been linked to improved clinical outcomes. Combination strategies may also pose an increased risk for antibiotic toxicity and Clostridioides difficile infection, and should therefore be balanced by understanding patient goals of care and underlying health conditions. Promising therapies that are in clinical development and/or under investigation include durlobactam–sulbactam, cefiderocol combination regimens, and bacteriophage therapy, which may over time eliminate the need for the continued use of polymyxins. Future goals for CRAB management include pathogen-focused treatment paradigms that are based on molecular mechanisms of resistance, local susceptibility rates, and the availability of well-tolerated, effective treatment options.
登录
查看更多内容
影响因子：
4.9
作者：
Cain, Sarah E.;Kohn, Joseph;Al-Hasan, Majdi N.
通讯作者：
Al-Hasan, Majdi N.
影响因子：
4.2
作者：
Alosaimy, Sara;Molina, Kyle C.;Rybak, Michael J.
通讯作者：
Rybak, Michael J.
影响因子：
3.8
作者：
Bardbari, Ali Mohammadi;Arabestani, Mohammad Reza;Bagheri, Kamran Pooshang
通讯作者：
Bagheri, Kamran Pooshang
影响因子：
--
作者：
Betrosian, Alex P.;Frantzeskaki, Frantzeska;Georgiadis, George
通讯作者：
Georgiadis, George
影响因子：
5.7
作者：
Ballouz T;Aridi J;Afif C;Irani J;Lakis C;Nasreddine R;Azar E
通讯作者：
Azar E