Not all carbapenem-resistant Pseudomonas aeruginosa strains are alike: tailoring antibiotic therapy based on resistance mechanisms.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Current Opinion in Infectious Diseases Pub Date : 2024-12-01 Epub Date: 2024-09-18 DOI:10.1097/QCO.0000000000001044
Marco Falcone, Valentina Galfo, Giusy Tiseo
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Abstract

Purpose of review: To correlate the resistance mechanisms and the susceptibility to new antibiotics in Pseudomonas aeruginosa .

Recent findings: Definition of antibiotic resistance in Pseudomonas aeruginosa is still debated. Carbapenem-resistant Pseudomonas aeruginosa (CRPA) and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) are used but which of them better correlate with the risk of mortality remains debated. Mechanisms underlying resistance in Pseudomonas aeruginosa are complex and may be combined, resulting in unpredictable phenotype and cross-resistance. Thus, not all CRPA are alike and tailoring antibiotic therapy on resistance mechanisms is challenging.

Summary: Current guidelines recommend the use of new antipseudomonal agents for CRPA or DTR-PA infections but they don't provide specific information on how tailoring antibiotic therapy on underlying resistance mechanisms. This review may be useful to understand which mechanisms are involved in CRPA and may have practical implications helping clinicians to select an appropriate antibiotic regimen. Several antibiotics are now available for Pseudomonas aeruginosa but their rational use is important to avoid development of future resistance. The knowledge of local epidemiology and most common resistance mechanisms may guide empirical therapy, but targeted antibiotic therapy should be re-evaluated as soon as susceptibility testing profile is available and selected according to Pseudomonas aeruginosa phenotype.

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并非所有耐碳青霉烯类的铜绿假单胞菌菌株都一样:根据耐药机制定制抗生素疗法。
综述目的将铜绿假单胞菌的耐药机制与对新抗生素的敏感性联系起来:铜绿假单胞菌对抗生素耐药性的定义仍存在争议。目前使用的是碳青霉烯类耐药铜绿假单胞菌(CRPA)和难治性耐药铜绿假单胞菌(DTR-PA),但哪种耐药与死亡风险更相关仍存在争议。铜绿假单胞菌产生耐药性的机制非常复杂,而且可能是多种机制共同作用的结果,从而导致表型和交叉耐药性难以预测。因此,并非所有的CRPA都是一样的,根据耐药机制定制抗生素治疗具有挑战性。摘要:目前的指南推荐使用新的抗假单胞菌药物治疗CRPA或DTR-PA感染,但并没有提供如何根据潜在耐药机制定制抗生素治疗的具体信息。本综述有助于了解 CRPA 涉及哪些机制,并可能对临床医生选择适当的抗生素方案有实际意义。目前有多种抗生素可用于治疗铜绿假单胞菌,但合理使用这些抗生素对避免未来耐药性的产生非常重要。对当地流行病学和最常见耐药机制的了解可以指导经验性治疗,但一旦获得药敏试验资料,就应重新评估有针对性的抗生素治疗,并根据铜绿假单胞菌的表型进行选择。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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