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首页> 外文期刊>The Journal of Antimicrobial Chemotherapy >Tigecycline for the treatment of multidrug-resistant Enterobacteriaceae: a systematic review of the evidence from microbiological and clinical studies.
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Tigecycline for the treatment of multidrug-resistant Enterobacteriaceae: a systematic review of the evidence from microbiological and clinical studies.

机译：替加环素用于治疗多重耐药性肠杆菌科：对微生物学和临床研究证据的系统评价。

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OBJECTIVES: Antimicrobial drug resistance is spreading among Enterobacteriaceae, limiting the utility of traditionally used agents. We sought to systematically review the microbiological activity and clinical effectiveness of tigecycline for multidrug-resistant (MDR) Enterobacteriaceae, including those resistant to broad-spectrum beta-lactams due to the expression of extended-spectrum beta-lactamases (ESBLs), AmpC enzymes and carbapenemases (including metallo-beta-lactamases). METHODS: PubMed was searched for articles including relevant data. RESULTS: Twenty-six microbiological and 10 clinical studies were identified. Tigecycline was active against more than 99% of 1936 Escherichia coli isolates characterized by any of the above resistance patterns (including 1636 ESBL-producing isolates) using the US Food and Drug Administration (FDA) breakpoint of susceptibility (MIC < or = 2 mg/L). Findings were not different using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoint (< or = 1 mg/L). Susceptibility rates for Klebsiella spp. with any of the above resistance patterns were 91.2% for 2627 isolates by the FDA criteria and 72.3% for 1504 isolates by the EUCAST criteria (92.3% for 2030 and 72.3% for 1284 ESBL-producing isolates, by the FDA and EUCAST criteria, respectively). The degree of microbiological activity of tigecycline against 576 MDR Enterobacter spp. isolates was moderate. In clinical studies, 69.7% of the 33 reported patients treated with tigecycline achieved resolution of an infection caused by a carbapenem-resistant or ESBL-producing or MDR Enterobacteriaceae. CONCLUSIONS: Tigecycline is microbiologically active against almost all of the ESBL or MDR E. coli isolates and the great majority of ESBL or MDR Klebsiella spp. isolates. Further evaluation of its clinical utility against such resistant Enterobacteriaceae, particularly regarding non-labelled indications, is warranted.
机译：目的：抗菌药耐药性在肠杆菌科中传播，限制了传统药物的使用。我们试图系统地审查替加环素对多药耐药（MDR）肠杆菌科的微生物活性和临床有效性，包括由于表达广谱β-内酰胺酶（ESBLs），AmpC酶和碳青霉烯酶（包括金属β-内酰胺酶）。方法：在PubMed中搜索包含相关数据的文章。结果：鉴定了26项微生物学和10项临床研究。使用美国食品和药物管理局（FDA）的敏感性折点（MIC <或= 2 mg /％），替加环素对1936年以上以任何上述耐药模式为特征（包括1636个产生ESBL的分离株）为特征的1936年大肠杆菌分离株具有活性。 L）。使用欧洲抗生素敏感性测试（EUCAST）断点（<或= 1 mg / L），发现没有不同。克雷伯菌属的敏感性。根据FDA标准，具有以上任何一种耐药模式的2627株分离株为91.2％，按照EUCAST标准，1504株分离株为72.3％（根据FDA和EUCAST标准，2030年为92.3％，产生1284种ESBL的分离株为72.3％ ）。替加环素对576 MDR肠杆菌属的微生物活性。分离株中等。在临床研究中，33例接受替加环素治疗的患者中有69.7％实现了对碳青霉烯耐药性或ESBL产生或MDR肠杆菌科引起的感染的缓解。结论：替加环素对几乎所有ESBL或MDR大肠杆菌分离物以及绝大多数ESBL或MDR克雷伯菌属具有微生物活性。隔离株。有必要进一步评估其针对此类耐药性肠杆菌科的临床效用，尤其是在未标记适应症方面。

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