Τίτλος:
New perspectives in the antibiotic treatment of mechanically ventilated patients with infections from Gram-negatives
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction: Ventilator-associated pneumonia (VAP) is a common and potentially fatal complication of mechanical ventilation that is often caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB). Despite the repurposing of older treatments and the novel antimicrobials, many resistance mechanisms cannot be confronted, and novel therapies are needed. Areas covered: We searched the literature for keywords regarding the treatment of GNB infections in mechanically ventilated patients. This narrative review presents new data on antibiotics and non-antibiotic approaches focusing on Phase 3 trials against clinically significant GNB that cause VAP. Expert opinion: Ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam stand out as new options for infections by Klebsiella pneumoniae carbapenemase-producing bacteria, whereas ceftolozane-tazobactam adds therapeutic flexibility in Pseudomonas aeruginosa infections with multiple resistance mechanisms. Ceftazidime-avibactam and ceftolozane-tazobactam have relevant literature. Aztreonam-avibactam holds promise for the treatment of infections by metallo-β-lactamase (MBL)-producing organisms. Recently approved cefiderocol possesses an extended antibacterial spectrum, including KPC- and MBL-producers. However, recently published data have toned down optimism about treating VAP caused by carbapenem-resistant Acinetobacter baumannii. For the latter, eravacycline may provide additional hope, pending pertinent data. Non-antibiotic treatments currently being considered as adjunct therapeutic approaches are welcome. Nevertheless, they will hopefully substitute current antimicrobials in the future. © 2020 Informa UK Limited, trading as Taylor & Francis Group.
Συγγραφείς:
Karvouniaris, M.
Pontikis, K.
Nitsotolis, T.
Poulakou, G.
Περιοδικό:
Expert Review of Anti-Infective Therapy
Εκδότης:
Taylor and Francis Ltd.
Λέξεις-κλειδιά:
ampicillin; avibactam; avibactam plus ceftazidime; aztreonam; beta lactamase AmpC; cefiderocol; ceftazidime; ceftolozane plus tazobactam; colistin; eravacycline; ertapenem; fosfomycin; imipenem; meropenem; meropenem plus vaborbactam; metallo beta lactamase; metronidazole; plazomicin; polymyxin B; relebactam; tigecycline; tobramycin; vaccine; antiinfective agent, Acinetobacter baumannii; antibiotic resistance; antibiotic therapy; artificial ventilation; bacteriophage; Bacteroides; bloodstream infection; continuous hemodiafiltration; controlled study; drug efficacy; drug safety; human; immunomodulation; innate immunity; Klebsiella pneumoniae; minimum inhibitory concentration; multidrug resistance; phase 3 clinical trial (topic); propensity score; Pseudomonas aeruginosa; Pseudomonas infection; randomized controlled trial (topic); Review; urinary tract infection; ventilator associated pneumonia; adverse event; animal; artificial ventilation; drug effect; Gram negative bacterium; Gram negative infection; isolation and purification; microbiology; multidrug resistance; procedures; ventilator associated pneumonia, Animals; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Pneumonia, Ventilator-Associated; Respiration, Artificial
DOI:
10.1080/14787210.2021.1859369
