常见多重耐药革兰阴性杆菌的临床和经济学影响

David

Antimicrobial Agents and Chemotherapy, March 2008, p. 813-821, Vol. 52, No. 3

MINIREVIEW

Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli
常见多重耐药革兰阴性杆菌的临床和经济学影响
Christian G. Giske,1* Dominique L. Monnet,2, Otto Cars,3 Yehuda Carmeli,4,5 on behalf of ReAct-Action on Antibiotic Resistance
Clinical Microbiology L2:02, Karolinska Institutet-MTC, Karolinska University Hospital Solna, SE-17176 Stockholm, Sweden,1 National Center for Antimicrobials and Infection Control, Statens SerumInstitut, Copenhagen, Denmark,2 Antibiotic Research Unit, Department of Medical Sciences, Clinical Bacteriology and Infectious Diseases, Uppsala University, Uppsala, Sweden,3 Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts,4 Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel5

During the last decade, the efforts to combat multidrug-resistant (MDR) microorganisms mainly focused on gram-positive bacteria, namely, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. While a large number of hospitals have implemented more rigorous infection control measures, drug companies have developed novel antimicrobial agents to combat these bacteria, resulting in several new compounds with novel mechanisms of action, e.g., linezolid and daptomycin (66). Paralleling the developments in gram-positive bacteria, infections caused by MDR gram-negative bacilli have become a growing problem (71). In a recent report the Infectious Diseases Society of America specifically addressed three categories of MDR gram-negative bacilli, namely, extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella spp., MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter spp. (70). Unfortunately, and contrary to what happened with gram-positive bacteria, no antibiotic from a new class has been developed specifically for MDR gram-negative bacilli. It might be argued that the glycylcycline tigecycline is an exception from the statement made above, but although this drug has in vitro activity against many MDR gram-negative bacilli, the drug was not developed specifically for the purpose of treating infections caused by such bacteria (64). Moreover, there are now a growing number of reports of cases of infections caused by gram-negative organisms for which no adequate therapeutic options exist (20). This return to the preantibiotic era has become a reality in many parts of the world (14, 55, 80). The present report aims at estimating the prevalence of infections due to MDR gram-negative bacilli, as well as the consequences with respect to mortality, hospital length of stay (LOS), and increased hospital costs.

The topics covered in this report are resistance to extended-spectrum cephalosporins in E. coli and Klebsiella pneumoniae, MDR (resistance to three or more antipseudomonal agents) (17) in P. aeruginosa, and carbapenem resistance in Acinetobacter spp. PubMed (www.ncbi.nih.gov; accessed on 31 October 2007) searches were performed by using the following search terms: (Escherichia coli OR Klebsiella pneumoniae) AND ESBL, (Escherichia coli OR Klebsiella pneumoniae) AND cephalosporin resistance, Pseudomonas AND multidrug resistance, Acinetobacter AND carbapenem resistance, antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND mortality, antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND length of stay, and antibiotic resistance AND (Pseudomonas OR Acinetobacter OR Escherichia coli OR Klebsiella) AND cost. The searches were performed to address the issues of prevalence, mortality, increased LOS, and increased hospital costs. Following the review of all abstracts, a total of 85 papers were considered relevant and were evaluated for the preparation of this report. All included papers on the clinical and economic impact of gram-negative bacilli included proper control groups. Only papers published in English were considered.

缭绕

要是有中文的该多好:'(

阿丹丹

老师的资料太有用了。。。真诚感谢，祝福。