多粘菌素价值重现（CMR巨作）

David

Clinical Microbiology Reviews, July 2008, p. 449-465, Vol. 21, No. 3

Polymyxins Revisited
多粘菌素价值重现
David Landman, Claudiu Georgescu, Don Antonio Martin, and John Quale*
Division of Infectious Diseases, SUNY-Downstate Medical Center, Brooklyn, New York

The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.



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* Corresponding author. Mailing address: Division of Infectious Diseases, Box 77, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203. Phone: (718) 270-2148. Fax: (718) 270-2465. E-mail: jquale@downstate.edu