PDF(Pubmed)
Abstract：
Patients with severe carbapenem-resistant Acinetobacter baumannii (CRAB) infections currently face significant treatment challenges. When patients display signs of infection and the clinical suspicion of CRAB infections is high, appropriate treatment should be immediately provided. However, current treatment plans and clinical data for CRAB are limited. Inherent and acquired resistance mechanisms, as well as host factors, significantly restrict options for empirical medication. Moreover, inappropriate drug coverage can have detrimental effects on patients. Most existing studies have limitations, such as a restricted sample size, and are predominantly observational or non-randomized, which report significant variability in patient infection severity and comorbidities. Therefore, a gold-standard therapy remains lacking. Current and future treatment options of infections due to CRAB were described in this review. The dose and considerable side effects restrict treatment options for polymyxins, and high doses of ampicillin-sulbactam or tigecycline appear to be the best option at the time of initial treatment. Moreover, new drugs such as durlobactam and cefiderocol have substantial therapeutic capabilities and may be effective salvage treatments. Bacteriophages and antimicrobial peptides may serve as alternative treatment options in the near future. The advantages of a combination antimicrobial regimen appear to predominate those of a single regimen. Despite its significant nephrotoxicity, colistin is considered a primary treatment and is often used in combination with antimicrobials, such as tigecycline, ampicillin-sulbactam, meropenem, or fosfomycin. The Infectious Diseases Society of America (IDSA) has deemed high-dose ampicillin-sulbactam, which is typically combined with high-dose tigecycline, polymyxin, and other antibacterial agents, the best option for treating serious CRAB infections. A rational combination of drug use and the exploration of new therapeutic drugs can alleviate or prevent the effects of CRAB infections, shorten hospital stays, and reduce patient mortality.
摘要：
严重耐碳青霉烯类鲍曼不动杆菌（CRAB）感染的患者目前面临重大的治疗挑战。当患者出现感染迹象，并且临床怀疑CRAB感染很高时，应立即提供适当的治疗。然而,目前CRAB的治疗计划和临床数据有限.固有和获得性抗性机制，以及宿主因素，显著限制了经验性药物的选择。此外，不适当的药物覆盖会对患者产生不利影响。大多数现有的研究都有局限性，例如有限的样本量，主要是观察性或非随机化的，报告患者感染严重程度和合并症的显着变异性。因此,仍然缺乏黄金标准疗法。本综述描述了CRAB感染的当前和未来治疗选择。剂量和相当大的副作用限制了多粘菌素的治疗选择，在初始治疗时，高剂量的氨苄西林-舒巴坦或替加环素似乎是最佳选择。此外，新的药物，如durlobactam和头孢地洛具有实质性的治疗能力，可能是有效的补救治疗。噬菌体和抗微生物肽可能在不久的将来作为替代治疗选择。联合抗微生物方案的优势似乎是单一方案的优势。尽管它有显著的肾毒性,粘菌素被认为是一种主要治疗方法，通常与抗菌药物联合使用，比如替加环素,氨苄西林-舒巴坦,美罗培南,或者磷霉素.美国传染病学会（IDSA）认为高剂量的氨苄西林-舒巴坦，通常与大剂量替加环素合用，多粘菌素,和其他抗菌剂，治疗严重CRAB感染的最佳选择。合理使用药物和探索新的治疗药物相结合，可以缓解或预防CRAB感染的影响，缩短住院时间,降低患者死亡率。
