Antimicrobial treatment of carbapenem-resistant Enterobacteriaceae infections
10.3760/cma.j.issn.1674-2397.2020.05.002
- VernacularTitle:碳青霉烯类抗生素耐药肠杆菌科细菌感染的治疗策略
- Author:
Hongliu CAI
1
;
Yake YAO
;
Hua ZHOU
Author Information
1. 浙江大学医学院附属第一医院重症医学科，杭州 310003
- From:
Chinese Journal of Clinical Infectious Diseases
2020;13(5):329-334
- CountryChina
- Language:Chinese
-
Abstract:
Carbapenem-resistant Enterobacteriaceae (CRE) mainly cause hospital-acquired infections, which have become an major threat in clinical practice and there are few antibacterial drugs available for CRE infection. At present, the main drugs for CRE treatment are polymyxin, tigecycline, ceftazidime-avibactam, fosfomycin and aminoglycoside antibiotics. Polymyxin and tigecycline are highly sensitive to CRE in vitro and are not affected by the type of carbapenemase produced by bacteria. Due to heterogeneous resistance and dose-related nephrotoxicity, polymyxin is often used in combination with other antibiotics. Tigecycline is difficult to reach sufficient concentrations in blood and alveolar lining fluid when using conventional dose. Therefore, it is necessary to increase the dose or to be used in combination with other drugs. Ceftazidime-avibactam lacks effective antibacterial activity against metalloenzyme-producing CRE, which can be used for the treatment of non metalloenzyme-producing CRE infection. The most common site of CRE colonization is the gastrointestinal tract. If the patient have intestinal mucosal destruction and decreased immune function, CRE can cause persistent bacteremia from intestinal blood.
