다제내성 그람음성균 감염의 항생제 치료
Antimicrobial Therapy for Infections Caused by Multidrug-Resistant Gram-Negative Bacteria
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초록
인류가 항생제를 세균성 감염질환의 치료제로 사용한 지70여 년이 지났다. 항생제의 도입으로 인해 감염 질환의 직접적인 치료는 물론이고 외과적 수술, 항암 요법 등 감염 합병증이 많이 발생하는 의학적 치료도 급속하게 발전할 수있었다. 항생제를 개발한 후 인류는 세균성 감염 질환을 쉽게 정복할 수 있는 듯했으나 항생제를 최초로 개발한 플레밍이 경고한 바대로 인류는 ‘항생제 내성’이라는 새로운 문제에 직면하게 되었다[1]. 특히 3가지 계열 이상의 항생제에내성을 보이는 ‘다제내성균’의 출현은 효과적인 항생제 치료를 어렵게 만들고 있고 중증 감염 환자의 치료 경과에 심각한 악영향을 미치고 있다[2,3]. 과거와 달리 다제내성균감염이 증가하고 있고 내성 기전도 매우 복잡해지고 있어임상 의사가 항생제를 적절하게 사용하는 것이 점점 어렵고 힘들어지고 있다. 더불어 21세기 임상 의사들에게는 항생제 내성 기전과 역학적 현황에 대한 지식이 필수적으로요구되고 있다.대장균, 녹농균 등의 그람음성균은 요로 감염, 복강 감염,폐렴 등을 일으킬 수 있는 중요한 병원균이며 최근 다제내성균이 증가추세이다. 특히 녹농균, Acinetobacter균은 carbapenem에도 내성을 보이는 경우가 흔해서 임상적으로 큰 문제가 된다[4]. 본 연제에서는 최근 의료관련 감염에서 심각한 문제가 되고 있는 다제내성 그람음성균 감염에 대한 적절한 항생제 치료에 대해서 논의하고자 한다.
Abstract
The incidence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has increased over the past decade and extensively drug-resistant (XDR) infections are now on the rise, especially in non-fermenters such as Pseudomonas and Acinetobacter species. Unfortunately, our therapeutic options for these pathogens are extremely limited. Infections due to antimicrobial- resistant bacteria are associated with a greater likelihood of inappropriate antimicrobial therapy, which has adverse effects on the outcomes of patients with serious infections. Physicians who are treating immunocompromised patients should be aware of not only the current epidemiological status of antimicrobial resistance but also appropriate antimicrobial therapy for MDR pathogens. Although carbapenems are considered a mainstay for the treatment of extended-spectrum beta-lactamase (ESBL) or AmpC β-lactamase-producing pathogens, antimicrobial stewardship for the appropriate use of carbapenems should be implemented to preserve these important antimicrobial agents. For carbapenem-resistant XDR infections, colistin and tigecycline could be considered a therapeutic option, based on the in vitro antibacterial spectrum, although the optimum treatment has not been established. This review provides a recent update of the antimicrobial therapeutic strategies for serious infections due to MDR or XDR Gram-negative bacteria, such as ESBL-producers and carbapenem-resistant pathogens.
참고문헌 (36)
- 강철인, "Antimicrobial Resistance in Asia: Current Epidemiology and Clinical Implications", Infection and Chemotherapy, 45(1), pp.22~31 (2013), 대한감염학회[DOI]
- Munoz-Price LS, "Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases", Lancet Infect Dis, 13, pp.785~796 (2013)
- Bassetti M, "New antibiotics for bad bugs: where are we?", Ann Clin Microbiol Antimicrob, 12, pp.22~ (2013)
- Papp-Wallace KM, "Carbapenems: past, present, and future", Antimicrob Agents Chemother, 55, pp.4943~4960 (2011)
- Endimiani A, "Cefepime: a reappraisal in an era of increasing antimicrobial resistance", Expert Rev Anti Infect Ther, 6, pp.805~824 (2008)
- Lee NY, "Cefepime therapy for monomicrobial bacteremia caused by cefepime-susceptible extended-spectrum beta-lactamase-producing Enterobacteriaceae: MIC matters", Clin Infect Dis, 56, pp.488~495 (2013)
- Wi YM, "Failure of cefepime therapy in neutropenic patients with extended-spectrum beta-lactamase-producing Gram-negative bacteraemia", Int J Antimicrob Agents, 33, pp.384~386 (2009)
- Nguyen HM, "Determining a clinical framework for use of cefepime and β-lactam", β-lactamase inhibitors in the treatment of infections caused by extendedspectrum-β-lactamase-producing Enterobacteriaceae, 2014, pp.69, 871~880
- Kang CI, "Piperacillin-tazobactam as an initial empirical therapy of bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae", J Infect, 64, pp.533~534 (2012)
- Park SH, "The efficacy of non-carbapenem antibiotics for the treatment of community-onset acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli", J Antimicrob Chemother, 69, pp.2848~2856 (2014)
- Rodríguez-Baño J, "β-Lactam", β-lactam inhibitor combinations for the treatment of bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli: a post hoc analysis of prospective cohorts, 2012, pp.54, ~167-174.
- Retamar P, "Impact of the MIC of piperacillin-tazobactam on the outcome of patients with bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli", Antimicrob Agents Chemother, 57, pp.3402~3404 (2013)
- Kang CI, "Extended-spectrum cephalosporins and the inoculum effect in tests with CTX-Mtype extended-spectrum β-lactamase-producing Escherichia coli: potential clinical implications of the revised CLSI interpretive criteria", Int J Antimicrob Agents, 43, pp.456~459 (2014)
- Tamma PD, "The use of cefepime for treating AmpC β-lactamase-producing Enterobacteriaceae", Clin Infect Dis, 57, pp.781~788 (2013)
- Alves MD, "Effect of cefepime dose on mortality of patients with Gram-negative bacterial bloodstream infections: a prospective cohort study", J Antimicrob Chemother, 69, pp.1681~1687 (2014)
- 이창섭, "Therapy of Infections due to Carbapenem-Resistant Gram-Negative Pathogens", Infection and Chemotherapy, 46(3), pp.149~164 (2014), 대한감염학회
- Falagas ME, "Antibiotic treatment of infections due to carbapenemresistant Enterobacteriaceae: systematic evaluation of the available evidence", Antimicrob Agents Chemother, 58, pp.654~663 (2014)
- van Duin D, "Carbapenem-resistant Enterobacteriaceae: a review of treatment and outcomes", Diagn Microbiol Infect Dis, 75, pp.115~120 (2013)
- Zavascki AP, "Combination therapy for carbapenem-resistant Gram-negative bacteria", Expert Rev Anti Infect Ther, 11, pp.1333~1353 (2013)
- Garonzik SM, "Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients", Antimicrob Agents Chemother, 55, pp.3284~3294 (2011)
- Stein GE, "Tigecycline: an update", Diagn Microbiol Infect Dis, 75, pp.331~336 (2013)
- Tumbarello M, "Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy", Clin Infect Dis, 55, pp.943~950 (2012)
- Bauer KA, "Extended-in-fusion cefepime reduces mortality in patients with Pseudomonas aeruginosa infections", Antimicrob Agents Chemother, 57, pp.2907~2912 (2013)
- Luyt CE, "Imipenem, meropenem, or doripenem to treat patients with Pseudomonas aeruginosa ventilator-associated pneumonia", Antimicrob Agents Chemother, 58, pp.1372~1380 (2014)
- Mandell L, "Doripenem: a new carbapenem in the treatment of nosocomial infection", Clin Infect Dis, 49(Suppl 1), pp.S1~S3 (2009)
- Ritchie DJ, "A review of intravenous minocycline for treatment of multidrug-resistant Acinetobacter infections", Clin Infect Dis, 59(Suppl 6), pp.S374~S380 (2014)
- López-Cortés LE, "Monotherapy versus combination therapy for sepsis due to multidrug-resistant Acinetobacter baumannii: analysis of a multicentre prospective cohort", J Antimicrob Chemother, 69 (2014)
- Ni W, "In vitro synergy of polymyxins with other antibiotics for Acinetobacter baumannii:a systematic review and meta-analysis", Int J Antimicrob Agents, 45, pp.8~18 (2015)
- Zusman O, "Systematic review and meta-analysis of in vitro synergy of polymyxins and carbapenems", Antimicrob Agents Chemother, 57, pp.5104~5111 (2013)
- Durante-Mangoni E, "Colistin and rifampicin compared with colistin alone for the treatment of serious infections due to extensively drug-resistant Acinetobacter baumannii: a multicenter, randomized clinical trial", Clin Infect Dis, 57, pp.349~358 (2013)
- Cho SY, "Breakthrough bacteremia due to extended-spectrum-β-lactamase-producing Klebsiella pneumoniae during combination therapy with colistin and tigecycline", Antimicrob Agents Chemother, 56, pp.4994~4996 (2012)
- 정혜선, "Antimicrobial Susceptibility of Stenotrophomonas maltophilia Isolates from Korea, and the Activity of Antimicrobial Combinations against the Isolates", Journal of Korean Medical Science, 28(1), pp.62~66 (2013), 대한의학회
- Cho SY, "Can levofloxacin be a useful alternative to trimethoprim-sulfamethoxazole for treating Stenotrophomonas maltophilia bacteremia?", Antimicrob Agents Chemother, 58, pp.581~583 (2014)
- Wang YL, "Monotherapy with fluoroquinolone or trimethoprim-sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections", Antimicrob Agents Chemother, 58, pp.176~182 (2014)
- Drawz SM, "New β-lactamase inhibitors: a therapeutic renaissance in an MDR world", Antimicrob Agents Chemother, 58, pp.1835~1846 (2014)
- Maseda E, "Ceftolozane", tazobactam (CXA 201) for the treatment of intra-abdominal infections, 2014, pp.12, 1311~1324