PDF(Pubmed)
Abstract：
It is estimated that antimicrobial resistance (AMR) is responsible for nearly 5 million human deaths worldwide each year and will reach 10 million by 2050. Carbapenem-resistant Acinetobacter baumannii (CRAB) infections represent the fourth-leading cause of death attributable to antimicrobial resistance globally, but a standardized therapy is still lacking. Among the antibiotics under consideration, Sulbactam/durlobactam seems to be the best candidate to replace current back-bone agents. Cefiderocol could play a pivotal role within combination therapy regimens. Due to toxicity and the pharmacokinetics/pharmacodynamics (PK/PD) limitations, colistin (or polymyxin B) should be used as an alternative agent (when no other options are available). Tigecycline (or minocycline) and fosfomycin could represent suitable partners for both NBLs. Randomized clinical trials (RCTs) are needed to better evaluate the role of NBLs in CRAB infection treatment and to compare the efficacy of tigecycline and fosfomycin as partner antibiotics. Synergism should be tested between NBLs and \"old\" drugs (rifampicin and trimethoprim/sulfamethoxazole). Huge efforts should be made to accelerate pre-clinical and clinical studies on safer polymyxin candidates with improved lung activity, as well as on the iv rifabutin formulation. In this narrative review, we focused the antibiotic treatment of CRAB infections in view of newly developed β-lactam agents (NBLs).
摘要：
据估计，抗生素耐药性（AMR）每年导致全球近500万人死亡，到2050年将达到1000万人。耐碳青霉烯类鲍曼不动杆菌（CRAB）感染是全球因抗菌素耐药性引起的第四大死亡原因。但是仍然缺乏标准化的治疗方法。在考虑的抗生素中，舒巴坦/durlobactam似乎是替代当前骨干药物的最佳候选药物。头孢地洛可在联合治疗方案中起关键作用。由于毒性和药代动力学/药效学（PK/PD）的限制，粘菌素（或多粘菌素B）应用作替代药物（当没有其他选择时）。替加环素（或米诺环素）和磷霉素可以代表两种NBL的合适伴侣。需要进行随机临床试验（RCT），以更好地评估NBLs在CRAB感染治疗中的作用，并比较替加环素和磷霉素作为伴侣抗生素的疗效。应测试NBLs与“旧”药物（利福平和甲氧苄啶/磺胺甲恶唑）之间的协同作用。应该做出巨大的努力，以加快对具有改善的肺活动的更安全的多粘菌素候选物的临床前和临床研究，以及IV利福布汀配方。在这篇叙述性评论中，鉴于新开发的β-内酰胺类药物(NBLs),我们重点关注CRAB感染的抗生素治疗.
