The hidden impact of antibacterial resistance in respiratory tract infection. Clinical failures: the tip of the iceberg?
The hidden impact of antibacterial resistance in respiratory tract infection. Clinical failures: the tip of the iceberg?
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DOI：
10.1016/s0954-6111(01)90022-8
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发表时间：
2001-06-01
影响因子：
4.3
通讯作者：
Garau, J
中科院分区：
文献类型：
--
作者：
Garau, J
在肺炎球菌性脑膜炎中，人们普遍认为肺炎链球菌的耐药性会影响临床结果。然而，耐药性增加对社区获得性呼吸道感染（RTIs）的临床影响尚不清楚。细菌根除应是抗菌治疗的目的。抗菌药物对感染病原体的药效学（效价和药代动力学）可用于预测细菌根除的潜力。对社区获得性呼吸道感染临床分离株的监测表明，在许多国家，耐药肺炎链球菌的流行呈上升趋势。一些已发表的临床试验结果表明，在正确剂量下，耐药并未影响氨基霉素的临床疗效。然而，新出现的数据表明，耐药性正在影响其他一些常规使用的抗菌素的疗效。有大环内酯类药物和氟喹诺酮类药物在社区获得性肺炎患者中的临床和细菌学失败的报道。最近的回顾性分析和越来越多的使用这些药物的临床失败的零星报告可能更能代表真实情况。这些报告表明有必要重新评估目前治疗社区获得性呼吸道感染的经验性治疗建议。
In pneumococcal meningitis, it is well accepted that resistance in Streptococcus pneumoniae compromises clinical outcome. However, the clinical impact of increasing resistance on community-acquired respiratory tract infections (RTIs) is less clear. Bacteriological eradication should be the aim of antimicrobial therapy. The pharmacodynamics (potency and pharmacokinetics) of an antimicrobial agent against the infecting pathogen can be used to predict the potential for bacterial eradication. Surveillance of clinical isolates from community-acquired RTIs shows that, in many countries, there is a trend towards an increasing prevalence of drug-resistant S. pneumoniae. Results from a number of published clinical trials suggest that resistance has not compromised the clinical efficacy of aminopenicillins when used at the correct dose. However, emerging data indicate that resistance is compromising the efficacy of some other routinely used antimicrobials. There are reports of clinical and bacteriological failure with macrolides and fluoroquinolones in patients with community-acquired pneumonia. Recent retrospective analyses and increasing sporadic reports of clinical failure with these agents may be more representative of the true situation. These reports suggest a need to reassess current empirical therapeutic recommendations for the treatment of community-acquired RTIs.