摘要: |
耐药革兰阴性菌(Gram-negative bacteria, GNB)的治疗难度大,对人类健康构成巨大威胁。GNB 主要病原体包括产超广谱 β- 内酰胺酶、产头孢菌素酶和耐碳青霉烯类细菌,其中,耐碳青霉烯类的鲍曼不动杆菌、铜绿假单胞菌和肠杆菌科细菌感染者最难治疗。近年来,国际上研发了多种具有抗 GNB 活性的抗生素。本文对 10 种新型抗生素进行综述,包括替莫西林、头孢地尔、头孢洛扎/他唑巴坦、头孢他啶/阿维巴坦、头孢吡肟/enmetazobactam、美罗培南/韦博巴坦、亚胺培南西司他丁/雷巴坦、氨曲南/阿维巴坦、依拉环素和普拉佐米星,介绍其作用机制、抗菌谱和潜在不良反应,并结合最新的医院获得性肺炎/呼吸机相关性肺炎(hospital-acquired pneumonia/ventilator-associated pneumonia, HAP/VAP)、腹腔感染(intra-abdominal infection, IAI)和复杂性泌尿道感染(complicated urinary tract infection, cUTI)的临床研究,总结其适应证及临床潜在应用范围。 |
关键词: 革兰阴性菌 抗生素 耐药性 碳青霉烯 |
DOI:10.12025/j.issn.1008-6358.2024.20231013 |
分类号:R 446.5 |
基金项目:上海市申康医院发展中心重大临床研究项目(SHDC2020CR2031B). |
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Update on clinical researches on novel antibiotics against Gram-negative bacteria |
YAO Yumeng1, CHEN Zhangzhang2, SHAN Yuzhang3, PAN Jue1, HU Bijie1,4
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1.Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Department of Pharmacology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;3.Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China;4.Department of Infection Control and Management, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Therapeutic options are limited for drug-resistant Gram-negative bacterial (GNB) infections, posing great threats to human health. Major pathogens include extended-spectrum β-lactamases or AmpC β-lactamases and carbapenem-resistant bacteria. Among them, carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae are the most difficult to be treated. In recent years, a variety of novel antibiotics with anti-GNB activity have been developed in the world. In this paper, ten novel antibiotics are reviewed, including temocillin, cefiderocol, ceftolozone/tazobactam, ceftazidime/avibactam, cefepime/enmetazobactam, meropenem/vaborbactam, imipenem-cilastatin/relebactam, aztreonam/avibactam, eravacycline and plazomicin. Their mechanisms of action, antibacterial spectrum and potential side effects were introduced. Combined with the latest clinical studies of hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP), intra-abdominal infection (IAI) and complicated urinary tract infection (cUTI), the indications and potential clinical applications are summarized. |
Key words: Gram-negative bacteria antibiotic resistance carbapenem |