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Антибиотики и Химиотерапия

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Инфекции, вызванные карбапенеморезистентными энтеробактериями: эпидемиология, клиническое значение и возможности оптимизации антибактериальной терапии

https://doi.org/10.37489/0235-2990-2020-65-5-6-41-69

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Аннотация

Устойчивость бактерий порядка Enterobacterales к карбапенемам может быть реализована разными механизмами, но наиболее распространённый — ферментативный, связанный с продукцией карбапенемаз. Карбапенемазы энтеробактерий характеризуются большим разнообразием; они представлены в трёх классах бета-лактамаз. Наиболее известные карбапенемазы относятся к классам А (ферменты KPC, GES), D (OXA-48) и B (металлоэнзимы NDM, VIM, IMP). Приводятся подробные их клинико-микробиологические характеристики, а также рекомендации по детекции. Карбапенемазы распространены повсеместно, в работе обсуждаются географические особенности распространения карбапенемаз в разных регионах мира; в России наибольшее распространение получили ферменты OXA-48 и NDM. Обсуждается клиническое значение карбапенемаз и факторы риска этих инфекций, к которым относятся: 1) предшествующая терапия карбапенемами; 2) высокий уровень карбапенемаз в отделении; 3) колонизация кишечника карбапенемазопродуцирующими энтеробактериями; 4) поездка в регион с высокой распространённостью карбапенемаз (4-й и 5-й эпидемиологический уровень). Обсуждаются возможности антибактериальной терапии инфекций, вызванных карбапенеморезистентными энтеробактериями, детально разбираются клинико-фармакологические характеристики антибиотиков (цефтазидим/авибактам, азтреонам, карбапенемы, полимиксины, тигециклин, фосфомицин), их эффективность и схемы терапии. Приводятся актуальные клинические данные, показывающие эффективность цефтазидима/авибактама в монотерапии при инфекциях, вызванных продуцентами карбапенемаз OXA-48 и KPC. Обсуждаются тактические вопросы ведения таких пациентов. Представлены алгоритмы эмпирической и целенаправленной терапии инфекций, вызванных карбапенемоустойчивыми энтеробактериями.

Об авторах

С. В. Яковлев
Первый Московский государственный медицинский университет им. И. М. Сеченова (Сеченовский Университет)
Россия

Яковлев Сергей Владимирович — д. м. н., профессор кафедры госпитальной терапии №2 Института клинической медицины

115446, Москва, Коломенский проезд 4, ГКБ им. С. С. Юдина, кафедра госпитальной терапии №2



М. П. Суворова
Первый Московский государственный медицинский университет им. И. М. Сеченова (Сеченовский Университет)
Россия

Суворова Маргарита Петровна — к. м. н., доцент кафедры госпитальной терапии №2 Института клинической медицины

Москва



А. О. Быков
Российский национальный исследовательский университет им. Н. И. Пирогова
Россия

Быков Андрей Олегович — аcсистент кафедры анестезиологии и реаниматологии, врач-реаниматолог ГКБ №40 ДЗ Москвы

Москва



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Для цитирования:


Яковлев С.В., Суворова М.П., Быков А.О. Инфекции, вызванные карбапенеморезистентными энтеробактериями: эпидемиология, клиническое значение и возможности оптимизации антибактериальной терапии. Антибиотики и Химиотерапия. 2020;65(5-6):41-69. https://doi.org/10.37489/0235-2990-2020-65-5-6-41-69

For citation:


Yakovlev S.V., Suvorova M.P., Bykov A.O. Infections Caused by Carbapenem-Resistant Enterobacterales: Epidemiology, Clinical Significance, and Possibilities for Antibiotic Therapy Optimization. Antibiotics and Chemotherapy. 2020;65(5-6):41-69. (In Russ.) https://doi.org/10.37489/0235-2990-2020-65-5-6-41-69

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