碳青霉烯耐药肠杆菌科细菌感染的抗菌药物治疗现状及研究进展

Current situation and research progress of drug therapy for carbapenem-resistant Enterobacteriaceae infection

目前国内治疗碳青霉烯耐药肠杆菌(CRE)感染的抗菌药主要有替加环素、多黏菌素、氨基糖苷类、喹诺酮和新上市的头孢他啶-阿维巴坦。国外一些新抗菌药物取得了较好的疗效,包括β-内酰胺类复合剂、头孢菌素类、四环素类和氨基糖苷类,以及一些正在研发的药物,都具有独特的优势。除了有效的抗菌药物,临床用药方案也与治疗效果有很大相关性。本文从抗菌机制和临床应用角度,综述了治疗CRE感染的相关药物,分目前国内现有抗菌药和新抗菌药研究进展两部分。简要介绍面对CRE感染,如何尽早给予恰当的目标治疗,根据菌株产碳青霉烯酶情况、结合PK/PD理论及病情给予合适的联合治疗,为临床治疗提供参考。

Currently, the main antibiotics for the treatment of carbapenem-resistant Enterobacteriaceae(CRE) infection in China include tigecycline, polymyxin, aminoglycosides and quinolones and the newly marketed ceftazidime-avibactam. Some antibiotics that have been marketed abroad have achieved good clinical efficacy, such as β-lactam compounds cephalosporins, tetracyclines and macrolides, and other products under development also have special advantages. In addition to effective antibacterial drugs, the clinical drug regimen also has a great correlation with the therapeutic effect. In this paper, related drugs for the treatment of CRE infection were reviewed from the perspectives of antibacterial mechanism and clinical application, containing two parts: current domestic antibiotics and new antibiotics research progress. It gives a brief introduction about taking appropriate targeted treatment as early as possible in response to CRE infection and conducting appropriate combined treatment on the basis of status of strains’ producing carbapenemases and combing with PK/PD theory and illness condition so as to provide guidance for clinical treatment.