Me tallo ßeta-lactamases: Đề kháng & tùy chọn trị liệu kháng sinh=Metallo ßeta-lactamases: Antimicrobial resistances & therapeutic options

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Tác giả: Quang Bính Trần

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.10-15

Bộ sưu tập: Metadata

ID: 243933

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Đề kháng kháng sinh đang gia tăng hiện nay là một vấn đề toàn cầu, đặc biệt đề kháng do các vi khuẩn Gram âm tại châu Á đã và đang là một thách thức lớn cho các thầy thuốc lâm sàng. Metallo-betalactamase có trên nhiễm sắc thể của các vi khuẩn không lên men gồm Stenotrophomonas maltophilia, Aeromonas spp., và Chryseobacterium spp., ở khắp nơi và liên quan đến lâm sàng ở mức độ vừa phải. Một tỉ lệ thấp của các chủng Bacteroides frag ilis có nhiễm sắc thể mang Metallo betalactamase. Các Metallo beta-lactamase (MBL) được quan tâm đặc biệt, nhất là MBL thu được (acquired MBL) lan rộng trong các vi khuẩn của họ Enterobacterales và Pseudomonas aeruginosa
liên quan đến kiểu hình kháng thuốc mở rộng (XDR), các vi khuẩn thường kháng với nhiều loại aminoglycosides, fluoroquinolones, các beta-lactams và các tác nhân khác. MBL KHÔNG bị ức chế bởi clavulanic acid, sulbactam, tazobactam, hoặc avibactam hoặc các chất phát triển từ penicillanic acid sulfones và diazabicyclooctanes. Không giống như các Carbapenemases KPC và OXA-48 like, các vi khuẩn điển hình thường không nhạy cảm với các kháng sinh kết hợp chất ức chế Beta lactamase như ceftazidime-avibactam, meropenemvaborbactam, imipenem-relebactam. Mặc dù một số kháng sinh ổn định và các thuốc kết hợp với chất ức chế Beta lactamase đang ở các giai đoạn khác nhau trong quá trình phát triển thuốc. Hiện nay Cefiderocol là một thuốc tiềm năng, các hợp chất phát triển boronate, taniborbactam… được biết đến và quan tâm đặc biệt. Những liệu pháp tiềm năng này và các lựa chọn điều trị hiện tại cho các vi khuẩn gram âm sinh MBL là trọng tâm của tổng quan này.Rising antimicrobial resistance is now a global problem, especially Gram-negative bacteria resistance in Asia has been a major challenge for clinicians. Metallo-beta lactamases are chromosomal and present ubiquitous in some non-fermenters including Stenotrophomonas maltophilia, Aeromonas spp., and Chryseobacterium spp., which are of modest clinical concern. A minority of Bacteroides fragilis strains have chromosomal encoded Metallo beta lactamase. Metallo beta-lactamases (MBLs) are of particular interest, especially as acquired MBLs spread in Enterobacterales and Pseudomonas aeruginosa
in association with the extended drug resistant phenotype (XDR), the bacteria are generally resistant to multiple aminoglycosides, fluoroquinolones as well as beta-lactams and other agents. MBLs are NOT inhibited by clavulanic acid, sulbactam, tazobactam, or avibactam or substances developed from penicillanic acid sulfones and diazabicyclooctanes. Unlike KPC and OXA-48- like carbapenemases, typical bacteria are generally not susceptible to beta-lactamase inhibitors combinations such as ceftazidimeavibactam, meropenem-vaborbactam, imipenemrelebactam. Although some antibiotics are stable and beta-lactamase inhibitors combination are at different stages in drug development. Currently Cefiderocol is a potent drug, the developmental compounds boronate, taniborbactam ... are known and of special concern. These potential therapies and current treatment options for MBLproducing gram negative bacteria are the focus of this review.

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