Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options

BMC Infectious Diseases

Research Article

Yoav Golan¹ 

[1] Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Disease, 800 Washington St, 02446, Boston, MA, USA;

关键词: Carbapenem;    Piperacillin-tazobactam;    Tigecycline;    Ceftolozane-tazobactam;    Ceftazidime-avibactam;    Complicated intra-abdominal infection;    Complicated urinary tract infection;   

DOI  :  10.1186/s12879-015-1054-1

 received in 2015-03-23, accepted in 2015-07-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundEmpiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug–resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.MethodsThis systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa.ResultsClinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.ConclusionsPractitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

【 授权许可】

CC BY   
© Golan. 2015