How to manage KPC infections

被引:44
作者
Bassetti, Matteo [1 ,2 ,3 ,4 ]
Peghin, Maddalena [2 ,3 ]
机构
[1] Azienda Osped Univ Santa Maria Misericordia, Clin Malattie Infett, Piazzale S Maria Misericordia 15, I-33100 Udine, Italy
[2] Univ Udine, Dept Med, Infect Dis Clin, Udine, Italy
[3] Azienda Sanitaria Univ, Integrata Udine, Udine, Italy
[4] Univ Genoa, Dept Hlth Sci, Genoa, Italy
关键词
carbapenem-resistant Enterobacteriaceae; Klebsiella pneumoniae carbapenemase producing K; pneumoniae; KPC; KPC-KP; MDR-GNB; multidrug-resistant Gram-negative; new antibiotics; RESISTANT KLEBSIELLA-PNEUMONIAE; IN-VITRO ACTIVITIES; CEFTAZIDIME-AVIBACTAM; TIGECYCLINE; MORTALITY; ENTEROBACTERIACEAE; FOSFOMYCIN; COLISTIN; THERAPY; STRATEGIES;
D O I
10.1177/2049936120912049
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Carbapenemase-producing Enterobacteriaceae represent an increasing global threat worldwide and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-KP) has become one of the most important contemporary pathogens, especially in endemic areas. Risk stratification and rapid diagnostics laboratory workflows are of paramount importance and indication for therapy of KPC-KP infection must be individualized according to the baseline characteristics of the patient and severity of infection. The optimal treatment of infection because of KPC-KP organisms is uncertain and antibiotic options are limited. The knowledge of the patient's pathophysiology, infection site, and application of the pharmacokinetic/pharmacodynamic principles on the basis of minimum inhibitory concentration (MIC) has progressively gained major relevance. Combination therapies including high-dose meropenem, colistin, fosfomycin, tigecycline, and aminoglycosides are widely used, with suboptimal results. In the past few years, new antimicrobials targeting KPC-KP have been developed and are now at various stages of clinical research. However, their optimal use should be guaranteed in the long term for delaying, as much as possible, the emergence of resistance. Strict infection control measures remain necessary. The aim of this review is to discuss the challenges in the management and treatment of patients with infections because KPC-KP and provide an expert opinion.
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页数:12
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