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Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium

Mesaros, N. ; Nordmann, P. ; Plésiat, P. ; Roussel-Delvallez, M. ; Van Eldere, J. ; Glupczynski, Y. ; Van Laethem, Y. ; Jacobs, F. ; Lebecque, P. ; Malfroot, A. ; Tulkens, P.M. ; Van Bambeke, F.

Clinical microbiology and infection, 2007-06, Vol.13 (6), p.560-578 [Periódico revisado por pares]

Oxford, UK: Elsevier Ltd

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Título:
Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium
Autor: Mesaros, N. ; Nordmann, P. ; Plésiat, P. ; Roussel-Delvallez, M. ; Van Eldere, J. ; Glupczynski, Y. ; Van Laethem, Y. ; Jacobs, F. ; Lebecque, P. ; Malfroot, A. ; Tulkens, P.M. ; Van Bambeke, F.
Assuntos: Anti-Bacterial Agents ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibacterial agents ; Antibiotic therapy ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Bacteriology ; Biological and medical sciences ; Cross Infection ; Cross Infection - drug therapy ; cystic fibrosis ; Drug Resistance, Multiple, Bacterial ; Errors of metabolism ; General aspects ; Human infectious diseases. Experimental studies and models ; Humans ; Infectious diseases ; Life Sciences ; Medical sciences ; Metabolic diseases ; Microbiology and Parasitology ; Miscellaneous hereditary metabolic disorders ; nosocomial infections ; Pharmacology. Drug treatments ; Pseudomonas aeruginosa ; Pseudomonas aeruginosa - drug effects ; Pseudomonas Infections ; Pseudomonas Infections - drug therapy ; resistance ; therapeutic options
É parte de: Clinical microbiology and infection, 2007-06, Vol.13 (6), p.560-578
Notas: ObjectType-Article-1
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Descrição: Pseudomonas aeruginosa is a major cause of nosocomial infections. This organism shows a remarkable capacity to resist antibiotics, either intrinsically (because of constitutive expression of β-lactamases and efflux pumps, combined with low permeability of the outer-membrane) or following acquisition of resistance genes (e.g., genes for β-lactamases, or enzymes inactivating aminoglycosides or modifying their target), over-expression of efflux pumps, decreased expression of porins, or mutations in quinolone targets. Worryingly, these mechanisms are often present simultaneously, thereby conferring multiresistant phenotypes. Susceptibility testing is therefore crucial in clinical practice. Empirical treatment usually involves combination therapy, selected on the basis of known local epidemiology (usually a β-lactam plus an aminoglycoside or a fluoroquinolone). However, therapy should be simplified as soon as possible, based on susceptibility data and the patient's clinical evolution. Alternative drugs (e.g., colistin) have proven useful against multiresistant strains, but innovative therapeutic options for the future remain scarce, while attempts to develop vaccines have been unsuccessful to date. Among broad-spectrum antibiotics in development, ceftobiprole, sitafloxacin and doripenem show interesting in-vitro activity, although the first two molecules have been evaluated in clinics only against Gram-positive organisms. Doripenem has received a fast track designation from the US Food and Drug Administration for the treatment of nosocomial pneumonia. Pump inhibitors are undergoing phase I trials in cystic fibrosis patients. Therefore, selecting appropriate antibiotics and optimising their use on the basis of pharmacodynamic concepts currently remains the best way of coping with pseudomonal infections.
Editor: Oxford, UK: Elsevier Ltd
Idioma: Inglês

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Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium

Mesaros, N. ; Nordmann, P. ; Plésiat, P. ; Roussel-Delvallez, M. ; Van Eldere, J. ; Glupczynski, Y. ; Van Laethem, Y. ; Jacobs, F. ; Lebecque, P. ; Malfroot, A. ; Tulkens, P.M. ; Van Bambeke, F.

Oxford, UK: Elsevier Ltd

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