治疗革兰氏阴性细菌感染的知识演变。

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Current Opinion in Infectious Diseases Pub Date : 2024-08-27 DOI:10.1097/qco.0000000000001055
Almudena Burillo,Emilio Bouza
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引用次数: 0

摘要

综述目的从 20 世纪下半叶至今,由非主要致病性革兰氏阴性杆菌(GNB)引起的感染报道越来越多。在磺胺类药物和青霉素 G 被发现之前,与革兰氏阳性感染相比,由革兰氏阴性杆菌引起的感染十分罕见。抗癌疗法的出现、外科手术的扩大、皮质类固醇的使用、假体材料的植入,以及对革兰氏阳性菌感染的更好控制,促进了目前革兰氏阳性菌感染的增加。然而,只有能够穿透 GNB 的双层膜并在其中存留足够时间的抗生素才具有抗菌活性。氨苄西林和随后的β-内酰胺类药物扩大了治疗 GNB 的范围。随着对β-内酰胺类药物高度耐药的 GNB 的增加,氨基糖苷类药物可能会与毒性较低的药物一起重新兴起。多粘菌素、四环素和氟喹诺酮类药物也可用于治疗 GNB。在中枢神经系统和前列腺等β-内酰胺类药物难以到达感染部位的特殊情况下,可能需要与其他药物联合使用。摘要窄谱免疫抑制疗法和抗生素、对人体微生物群干预最小的抗菌药物以及即时诊断方法,这些都是设想一个目前在感染性病理学中占主导地位的细菌失去其优势的未来所必需的。
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The evolution of knowledge for treating Gram-negative bacterial infections.
PURPOSE OF REVIEW Infections caused by nonprimarily pathogenic Gram-negative bacilli (GNB) have been increasingly reported from the second half of the 20th century to the present. This phenomenon has expanded during the antibiotic era and in the presence of immunodeficiency.Before the discovery of sulphonamides and penicillin G, infections caused by GNB were rare compared to Gram-positive infections. The advent of anticancer therapy, the expansion of surgical procedures, the use of corticosteroids, and the implantation of prosthetic materials, along with better control of Gram-positive infections, have promoted the current increase in GNB infections.GNB have similar antimicrobial targets to Gram-positive bacteria. However, only antibiotics that can penetrate the double membrane of GNB and remain in them for a sufficient duration have antibacterial activity against them. RECENT FINDINGS Sulphonamides and early penicillins had limited activity against GNB. Ampicillin and subsequent beta-lactams expanded their spectrum to treat GNB. Aminoglycosides may re-surge with less toxic drugs, as highly resistant to beta-lactams GNB rise. Polymyxins, tetracyclines, and fluoroquinolones are also used for GNB. Combinations with other agents may be needed in specific cases, such as in the central nervous system and prostate, where beta-lactams may have difficulty reaching the infection site.Alternatives to current treatments must be sought in the discovery of new drug families and therapies such as phage therapy combined with antibiotics. SUMMARY Narrower-spectrum immunosuppressive therapies and antibiotics, antimicrobials that minimally intervene with the human microbiota, and instant diagnostic methods are necessary to imagine a future where currently dominant bacteria in infectious pathology lose their preeminence.
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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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