New Therapeutic Options for Treatment of Multi-drug Resistant Gram-negative Microorganisms

Abstract

Recently, antibiotic resistance in gram-negative microorganisms has been increased. While multi-drug resistant and extensively-drug resistant gram-negative strains are the most common cause of healthcare-associated infections, and they are related with high morbidity and mortality. This increase in antimicrobial resistance results in frequently inappropriate use of antibiotics. Effective antibiotic options are decreasing, in proportion to this, new antibiotic development is less than the resistance. However, datas related with on some newly developed and developing antibiotics, which are included in the old antimicrobial classes, are increasing. In this review, it is aimed to present new antibiotic options that are being used and are being developed for the treatment of infections which are caused by antibiotic resistant gram-negative microorganisms are presented. Double carbapenem therapy has been studied and evaluated as a treatment option for carbapenemase producing Enterobacteriaceae. Ceftazidime -avibactam, meropenem - vaborbactam and ceftolozan - tazobactam, which are new beta-lactam beta-lactamase inhibitors, will soon appear to be included in daily clinical practice. In addition, imipenem/cilastatin - relebactam, eravacycline, plasomycin and cefiderocol are new antibiotics that are still being studied for efficacy and safety. Although, with all these new treatment options, we get stronger against infections that are caused by drug resistant gram-negatives, the best way to combat drug resistant microorganisms is to prevent the resistance and spread of resistant clones the rational use of antibiotics.

Keywords

• Gram-negative
• Antibiotic Resistance
• Carbapenemases
• Multi-drug Resistance

Çoklu İlaca Dirençli Gram-negatif Mikroorganizmalarla Gelişen Enfeksiyonlarda Yeni Tedavi Seçenekleri

Abstract

Günümüzde gram-negatif mikroorganizmalarda direnç giderek artmaktadır. Çoklu ilaca dirençli ve yaygın ilaca dirençli suşlar ile gelişen enfeksiyonlar hastalarda sağlık bakımı ilişkili enfeksiyonların en sık nedeni iken, yüksek mortalite ve morbidite ile ilişkilidir. Dirençteki bu artış antibiyotiklerin artmış ve kimi zaman uygunsuz kullanımıyla sonuçlanmaktadır. Etkin antibiyotik seçenekleri azalmakta, buna oranla yeni geliştirilen antibiyotik sayısı direnç karşısında daha az izlenmektedir. Ancak yine de eski sınıflara dahil edilen yeni geliştirilen ve geliştirilmekte olan bazı antibiyotikler ile ilgili veriler artmaktadır. Bu derlemede, antibiyotik dirençli gram-negatiflerle gelişen enfeksiyonların tedavisi için geliştirilen, kullanılmakta olan ve geliştirilmekte olan yeni antibiyotik seçenekleri sunulmuştur. İkili karbapenem tedavisi, karbapenemaz üreten enterikler için bir seçenek olarak değerlendirilmiş ve çalışılmıştır. Yeni beta laktam - beta laktamaz inhibitörleri olan seftazidim - avibaktam, meropenem- vaborbaktam ve seftolozan - tazobaktam da yakında günlük klinik pratikte yerini alacak gibi görünmektedir. Buna ek olarak, imipenem/silastatin - relebaktam, eravasiklin, plazomisin ve sefiderokol de etkinlik ve güvenilirlik açısından çalışmaları sürmekte olan yeni antibiyotiklerdir. Tüm bu yeni tedavi seçenekleri ile elimiz dirençli gram-negatiflerle gelişen enfeksiyonlara karşı güçlenmekte olsa da asıl olan direncin ve yayılımının önlenmesi, bunun için de antibiyotiklerin akılcı bir şekilde kullanılmasıdır.

Keywords

• Gram-negatif
• Antibiyotik Direnci
• Karbapenemaz
• Çoklu İlaç Direnci

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