在耐碳青霉烯类鲍曼不动杆菌引起的重症院内肺炎期间,我们是否应该以及如何优化头孢哌酮的使用?一种观点。

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-06-05 DOI:10.1016/j.jgar.2024.05.014
Julien Massol , Aurélien Dinh , Katy Jeannot , Clara Duran , Frédérique Bouchand , Anaïs Potron , Laurent Dortet , François Jehl
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引用次数: 0

摘要

导言:鲍曼不动杆菌(Acinetobacter baumannii)被美国疾病控制和预防中心(CDC)列为 "紧急威胁",因为它能够获得并发展出对多种抗生素的耐药性。因此,它是医疗机构中最令人担忧的病原体之一,耐碳青霉烯类鲍曼不动杆菌(CRAB)感染的发病率越来越高,发病率和死亡率也越来越高。因此,人们一直在努力寻找新的治疗方案,头孢哌酮就是其中之一。我们旨在回顾有关头孢克洛用于治疗耐碳青霉烯类鲍曼不动杆菌引起的重症院内肺炎的现有证据 方法:从 2017 年到 2023 年进行了一次全面回顾,涵盖了 Pubmed、Scopus 和 Embase 等数据库中的文章,以及 ECCMID 2023 的会议论文集。主要关注点是鲍曼不动杆菌和头孢羟氨苄引起的重症院内肺炎:Cefiderocol通过苷元转运途径靶向质膜周围空间青霉素结合蛋白(PBPs),有望对抗多重耐药革兰氏阴性杆菌。但它在治疗 CRAB 肺炎方面的有效性仍存在争议。CREDIBLE 试验报告称,与现有的最佳治疗方法相比,头孢羟氨苄的死亡率更高,而其他队列研究则显示出截然不同的结果。患者差异和药代动力学因素可能是造成这些差异的原因。推荐的头孢羟氨苄剂量方案可能达不到理想的药代动力学目标,尤其是在重症患者和肺部感染患者中。临床断点中忽略了阻碍头孢羟氨苄通过铁转运体进入细菌的肺部因素。优化剂量或联合用药方案可提高感染部位的暴露率和治疗效果:结论:需要进一步研究确定头孢羟氨苄的最佳剂量和给药(单药治疗与双药治疗、持续输注与间歇输注),以治疗严重的鲍曼不动杆菌性肺炎。
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Should we, and how to, optimize cefiderocol administration during severe nosocomial pneumonia due to carbapenem-resistant Acinetobacter baumanii? A viewpoint

Objectives

Acinetobacter baumannii is classified by the centre for Disease Control and Prevention (CDC) as an "urgent threat" due to its ability to acquire and develop resistance to multiple classes of antibiotics. As a result, it is one of the most concerning pathogens in healthcare settings, with increasing incidence of infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) associated with high morbidity and mortality rates. Therefore, there are ongoing efforts to find novel treatment options, one of which is cefiderocol. We aim to review available evidence on cefiderocol use for severe nosocomial pneumonia due to carbapenem-resistant Acinetobacter baumannii.

Methods

A comprehensive review was conducted from 2017 to 2023, covering articles from databases such as Pubmed, Scopus, and Embase, along with conference proceedings from ECCMID 2023. The primary focus was on severe nosocomial pneumonia due A. baumannii and cefiderocol.

Discussion

Cefiderocol, targeting periplasmic space Penicillin-Binding Proteins (PBPs) via siderophore transport pathways, exhibits promise against multi-drug resistant Gram-negative bacilli. Its effectiveness in treating CRAB pneumonia remains debated. The CREDIBLE trial reported higher mortality with cefiderocol compared to the best available treatment, while other cohort studies showed contrasting outcomes. Patient variations and pharmacokinetic factors may underlie these discrepancies. The recommended cefiderocol dosage regimen may fall short of desired pharmacokinetic targets, especially in critically ill patients and lung infections. Pulmonary factors hindering cefiderocol's entry into bacteria through iron transporters are overlooked in clinical breakpoints. Optimized dosing or combination regimens may enhance infection site exposure and outcomes.

Conclusions

Further research is needed to determine the optimal cefiderocol dosage and administration (mono vs. dual therapy, continuous vs. intermittent infusion), in severe Acinetobacter baumannii nosocomial pneumonia.

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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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