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Erschienen in: Wiener klinisches Magazin 5/2019

07.08.2019 | Infektiologie

Neue β‑Laktam-Antibiotika und β‑Laktamase-Inhibitoren gegen multiresistente Gram-negative Erreger

verfasst von: PD Dr. Dipl.-Kfm. Alexander Mischnik, Prof. Dr. Christoph Lübbert, PD Dr. Nico T. Mutters

Erschienen in: Wiener klinisches Magazin | Ausgabe 5/2019

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Zusammenfassung

Hintergrund

Die rasche Zunahme multiresistenter Gram-negativer Erreger (MRGN) ist ein drängendes und weitgehend ungelöstes globales Problem. Die Behandlungsoptionen bei diesen Erregern sind sehr stark eingeschränkt. Nur wenige neue Substanzen sind zugelassen worden oder befinden sich aktuell in klinischen Phase-II/III-Studien.

Ziel der Arbeit

Übersichtliche Vorstellung der bislang vorliegenden Daten zu den neuen β‑Laktam-Antibiotika und β‑Laktamase-Inhibitor-Kombinationen. Die neuen Makrolide, Ketolide und Aminoglykoside werden nicht adressiert.

Material und Methoden

Selektive Literaturrecherche zu den Substanzen Ceftazidim/Avibactam, Ceftolozan/Tazobactam, Imipenem/Cilastatin + Relebactam, Meropenem/Vaborbactam, Aztreonam/Avibactam und Cefiderocol unter Einbeziehung aktuell registrierter Studien mit klinischer Auswertung und Datenanalyse.

Ergebnisse

Die Entwicklung neuer Substanzen zur Therapie von Infektionen durch MRGN eröffnet neue Optionen bei Infektionen durch besonders schwierig zu behandelnde Erreger, insbesondere Erreger, die Carbapenemasen vom Klebsiella-pneumoniae-Carbapenemase (KPC) und OXA-48-Typ bilden. β‑Laktamase-Bildner werden durch die neuen Substanzen oder Kombinationen unterschiedlich stark gehemmt; allerdings fehlen noch immer ausreichende Therapieoptionen für Metallo-β-Laktamase-Bildner sowie Infektionen durch multiresistente Pseudomonas-aeruginosa- und Acinetobacter-spp.-Stämme.

Schlussfolgerung

Vielfach sind die klinischen Daten noch indifferent und stammen aus uneinheitlich definierten Patientenkollektiven. Direkte Vergleiche mit etablierten Behandlungsstrategien wie dem „Last-resort-Einsatz“ von Polymyxinen sind kaum möglich. Leider sind auch bereits Fälle einer raschen Resistenzentwicklung beschrieben. Der Stellenwert der Toxizität und optimalen Dosierung – auch bei Organversagen oder Organersatzverfahren wie Dialyse – ist vielfach noch unklar.
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Metadaten
Titel
Neue β‑Laktam-Antibiotika und β‑Laktamase-Inhibitoren gegen multiresistente Gram-negative Erreger
verfasst von
PD Dr. Dipl.-Kfm. Alexander Mischnik
Prof. Dr. Christoph Lübbert
PD Dr. Nico T. Mutters
Publikationsdatum
07.08.2019
Verlag
Springer Vienna
Erschienen in
Wiener klinisches Magazin / Ausgabe 5/2019
Print ISSN: 1869-1757
Elektronische ISSN: 1613-7817
DOI
https://doi.org/10.1007/s00740-019-00297-1