Combatting resistant enterococcal infections: a pharmacotherapy review

被引:67
作者
Mercuro, Nicholas J. [1 ,2 ]
Davis, Susan L. [1 ,2 ]
Zervos, Marcus J. [3 ,4 ]
Herc, Erica S. [3 ]
机构
[1] Wayne State Univ, Eugene Applebaum Coll Pharm & Hlth Sci, Serv Pharm, Detroit, MI USA
[2] Henry Ford Hosp, Serv Pharm, Detroit, MI 48202 USA
[3] Henry Ford Hosp, Dept Internal Med, Div Infect Dis, Detroit, MI 48202 USA
[4] Wayne State Univ, Sch Med, Detroit, MI USA
关键词
Antibiotic resistance; Enterococcus; Gram-positive antibiotics; antimicrobial stewardship; URINARY-TRACT-INFECTIONS; GRAM-POSITIVE INFECTIONS; BLOOD-STREAM INFECTIONS; HIGH-DOSE DAPTOMYCIN; IN-VITRO ACTIVITY; VANCOMYCIN-RESISTANT; MULTIDRUG-RESISTANT; EXPERIMENTAL ENDOCARDITIS; CLINICAL-OUTCOMES; BETA-LACTAMS;
D O I
10.1080/14656566.2018.1479397
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: The role of enterococci in infectious diseases has evolved from a gut and urinary commensal to a major pathogen of concern. Few options exist for resistant enterococci, and appropriate use of the available agents is crucial.Areas covered: Herein, the authors discuss antibiotics with clinically useful activity against Enterococcus faecalis and E. faecium. The article specifically discusses: antibiotics active against enterococci and their mechanism of resistance, pharmacokinetic and pharmacodynamic principles, in vitro combinations, and clinical studies which focus on urinary tract, intra-abdominal, central nervous system, and bloodstream infections due to enterococci.Expert opinion: Aminopenicillins are preferred over all other agents when enterococci are susceptible and patients can tolerate them. Daptomycin and linezolid have demonstrated clinical efficacy against vancomycin-resistant enterococci (VRE). Synergistic combinations are often warranted in complex infections of high inoculum and biofilms while monotherapies are generally appropriate for uncomplicated infections. Although active against resistant enterococci, the pharmacokinetics, efficacy and safety of tigecycline and quinupristin/dalfopristin can problematical for severe infections. For cystitis, amoxicillin, nitrofurantoin, or fosfomycin are ideal. Recently, approved agents such as tedizolid and oritavancin have good in vitro activity against VRE but clinical studies against other resistant enterococci are lacking.
引用
收藏
页码:979 / 992
页数:14
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