多重耐药鲍曼控制和治疗进展（柳叶刀感染分册）

David

                               
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Volume 8, Issue 12, December 2008, Pages 751-762
Copyright © 2008 Elsevier Ltd All rights reserved. Review Current control and treatment of multidrug-resistant Acinetobacter baumannii infections
多重耐药鲍曼控制和治疗进展

Drosos E Karageorgopoulos MDa and Dr Matthew E Falagas MDa, b, c,

                               
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,

                               
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aAlfa Institute of Biomedical Sciences (AIBS), Athens, Greece
bDepartment of Medicine, Henry Dunant Hospital, Athens, Greece
cDepartment of Medicine, Tufts University School of Medicine, Boston, MA, USA


Available online 17 November 2008.


SummaryInstitutional outbreaks caused by Acinetobacter baumannii strains that have acquired multiple mechanisms of antimicrobial drug resistance constitute a growing public-health problem. Because of complex epidemiology, infection control of these outbreaks is difficult to attain. Identification of potential common sources of an outbreak, through surveillance cultures and epidemiological typing studies, can aid in the implementation of specific control measures. Adherence to a series of infection control methods including strict environmental cleaning, effective sterilisation of reusable medical equipment, attention to proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance and support, are required for the containment of an outbreak. Effective antibiotic treatment of A baumannii infections, such as ventilator-associated pneumonia and bloodstream infections, is also of paramount importance. Carbapenems have long been regarded as the agents of choice, but resistance rates have risen substantially in some areas. Sulbactam has been successfully used in the treatment of serious A baumannii infections; however, the activity of this agent against carbapenem-resistant isolates is decreasing. Polymyxins show reliable antimicrobial activity against A baumannii isolates. Available clinical reports, although consisting of small-sized studies, support their effectiveness and mitigate previous concerns for toxicity. Minocycline, and particularly its derivative, tigecycline, have shown high antimicrobial activity against A baumannii, though relevant clinical evidence is still scarce. Several issues regarding the optimum therapeutic choices for multidrug-resistant A baumannii infections need to be clarified by future research.

Article OutlineIntroduction Control of outbreaks of multidrug-resistant A baumannii Ability to cause outbreaks Epidemiology of outbreaks Epidemiological analysis of an outbreak Potential common sources Risk factors for acquisition of outbreak strains Infection control measuresTreatment of multidrug-resistant A baumannii infections Pathogenicity of A baumannii and infection outcomes Antimicrobial therapy Carbapenems Polymyxins Sulbactam Tetracyclines and glycylcyclines Aminoglycosides Fluoroquinolones Combination therapyFuture prospects Conclusions Search strategy and selection criteria References

星火

谢提供,很实际的问题,需要专业翻一番,就好啦:handshake

David

ummaryInstitutional outbreaks caused by Acinetobacter baumannii strains that have acquired multiple mechanisms of antimicrobial drug resistance constitute a growing public-health problem. (总结: 由多重耐药的鲍曼不动杆菌引起的医院感染暴发已经成为现实的公共卫生问题。) Because of complex epidemiology, infection control of these outbreaks is difficult to attain.（由于流行病特征的复杂性，对这些暴发采取适当的感控措施非常困难。） Identification of potential common sources of an outbreak, through surveillance cultures and epidemiological typing studies, can aid in the implementation of specific control measures. （通过监测培养和流行病学分型研究来鉴别暴发中的潜在共同来源能够帮助实施适当的有针对性地控制措施。）Adherence to a series of infection control methods including strict environmental cleaning, effective sterilisation of reusable medical equipment, attention to proper hand hygiene practices, and use of contact precautions, together with appropriate administrative guidance and support, are required for the containment of an outbreak. （一系列感控方法包括严格的环境清洁，有效地对重复使用的医疗物品消毒，注意手卫生，使用接触隔离措施，适当的行政指导和支持。）Effective antibiotic treatment of A baumannii infections, such as ventilator-associated pneumonia and bloodstream infections, is also of paramount importance. （有效地应用抗生素治疗鲍曼感染也十分重要，鲍曼感染如呼吸机相关肺炎和血流感染。）Carbapenems have long been regarded as the agents of choice, but resistance rates have risen substantially in some areas. （碳青霉烯类长期被认为可选择的抗生素，但在某些地方耐药率持续上升。）Sulbactam has been successfully used in the treatment of serious A baumannii infections; however, the activity of this agent against carbapenem-resistant isolates is decreasing. （舒巴坦成功用于治疗严重鲍曼感染，然而，对碳青霉烯类耐药的菌株其活性正在下降。）Polymyxins show reliable antimicrobial activity against A baumannii isolates.（多粘菌素显示出可靠的对鲍曼的抗菌活性。） Available clinical reports, although consisting of small-sized studies, support their effectiveness and mitigate previous concerns for toxicity. （可用的临床报告，尽管只是小样本的研究，支持多粘菌素的有效性同时也减轻了之前人们对其毒性的担心。）Minocycline, and particularly its derivative, tigecycline, have shown high antimicrobial activity against A baumannii, though relevant clinical evidence is still scarce. （米诺环素，尤其是其衍生物，替加环素已经显示出对鲍曼的高度抗菌活性，尽管仍然缺乏相关的临床证据。）Several issues regarding the optimum therapeutic choices for multidrug-resistant A baumannii infections need to be clarified by future research.（关于优化治疗多重耐药鲍曼感染的一些问题还需要深入研究。）