Abstract:Polymyxins are often the only agents that remain in vitro active against extensively resistant bacterial pathogens. However, the use of polymyxins is compromised by the number of unresolved issues, including the technical aspects of antimicrobial susceptibility testing, pharmacokinetic and pharmacodynamics parameters, optimal dosing regimens, and combined use with other antibiotics. All of the aspects of polymyxin use are discussed in detail in recently published «International consensus guidelines for the opt… Show more
Infections are a common complication in patients with hematological malignancies, especially during neutropenia. Recently, an increase in multidrug-resistant gram-negative pathogens has been observed in the etiology of infectious complications, including carbapenem-resistant Enterobacteriaceae. However, therapeutic options for treatment of these infections are limited. The review represents treatment options for infections caused by carbapenem-resistant Enterobacteriaceae, including the use of reserve drugs such as polymyxin, carbapenems, tigecycline, as well as a new antibiotic – ceftazidime-avibactam, which contains a new β-lactamase inhibitor with unique properties.
Infections are a common complication in patients with hematological malignancies, especially during neutropenia. Recently, an increase in multidrug-resistant gram-negative pathogens has been observed in the etiology of infectious complications, including carbapenem-resistant Enterobacteriaceae. However, therapeutic options for treatment of these infections are limited. The review represents treatment options for infections caused by carbapenem-resistant Enterobacteriaceae, including the use of reserve drugs such as polymyxin, carbapenems, tigecycline, as well as a new antibiotic – ceftazidime-avibactam, which contains a new β-lactamase inhibitor with unique properties.
Показана лидирующая роль антибиотикорезистентных штаммов K. pneumoniae в этиологической структуре внутрибольничных инфекций. Рассмотрены основные механизмы возникновения и распространения устойчивости K. pneumoniae к карбапенемам и полимиксинам. Показано значение карбапенемаз KPC, OXA-48 и NDM в формировании множественной и экстремальной антибиотикорезистентности. Оценена динамика распространения колистинорезистентных карбапенемазопродуцирующих госпитальных штаммов в 2016–2020 гг. Выполнены детекция генов карбапенемаз и определение чувствительности антибиотикорезистентных штаммов к комбинациям антибиотиков. Проанализированы варианты комбинированной антимикробной терапии пациентов с инфекциями, вызванными экстремально антибиотико-резистентными штаммами K. pneumoniae, отражены пути ее оптимизации.
The leading role of antibiotic-resistant K. pneumoniae strains in the etiological structure of nosocomial infections has been shown. The main mechanisms of the emergence and spread of resistance of K. pneumoniae to carbapenems and polymyxins are considered. The importance of carbapenemases KPC, OXA-48 and NDM in the formation of multidrug resistance and extensively drug resistance was studied. The dynamics of the spread of colistin-resistant carbapenemase- producing hospital strains in 2016-2020 was estimated. Carbapenemase genes were detected and the sensitivity of antibiotic-resistant strains to antibiotic combinations was determined. Variants of combined antimicrobial therapy for patients with infections caused by extensively drug-resistant strains of K. pneumoniae were analyzed, ways of its optimization were indicated.
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