Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections

In recent years, the worldwide spread of the so-called high-risk clones of multidrug-resistant or extensively drug-resistant (MDR/XDR) has become a public health threat. This article reviews their mechanisms of resistance, epidemiology, and clinical impact and current and upcoming therapeutic option...

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Vydané v:Clinical microbiology reviews Ročník 32; číslo 4
Hlavní autori: Horcajada, Juan P, Montero, Milagro, Oliver, Antonio, Sorlí, Luisa, Luque, Sònia, Gómez-Zorrilla, Silvia, Benito, Natividad, Grau, Santiago
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 18.09.2019
Predmet:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Humans
Pseudomonas aeruginosa - drug effects
Pseudomonas Infections - drug therapy
Pseudomonas Infections - epidemiology
Pseudomonas Infections - therapy
Pseudomonas aeruginosa
ISSN:1098-6618, 1098-6618
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Popis
Shrnutí:In recent years, the worldwide spread of the so-called high-risk clones of multidrug-resistant or extensively drug-resistant (MDR/XDR) has become a public health threat. This article reviews their mechanisms of resistance, epidemiology, and clinical impact and current and upcoming therapeutic options. and treatment studies and pharmacokinetic and pharmacodynamic (PK/PD) models are discussed. Polymyxins are reviewed as an important therapeutic option, outlining dosage, pharmacokinetics and pharmacodynamics, and their clinical efficacy against MDR/XDR infections. Their narrow therapeutic window and potential for combination therapy are also discussed. Other "old" antimicrobials, such as certain β-lactams, aminoglycosides, and fosfomycin, are reviewed here. New antipseudomonals, as well as those in the pipeline, are also reviewed. Ceftolozane-tazobactam has clinical activity against a significant percentage of MDR/XDR strains, and its microbiological and clinical data, as well as recommendations for improving its use against these bacteria, are described, as are those for ceftazidime-avibactam, which has better activity against MDR/XDR , especially strains with certain specific mechanisms of resistance. A section is devoted to reviewing upcoming active drugs such as imipenem-relebactam, cefepime-zidebactam, cefiderocol, and murepavadin. Finally, other therapeutic strategies, such as use of vaccines, antibodies, bacteriocins, anti-quorum sensing, and bacteriophages, are described as future options.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ObjectType-Review-3
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ISSN:1098-6618
1098-6618
DOI:10.1128/CMR.00031-19