Госпитальные инфекции, вызванные Pseudomonas aeruginosa. Распространение и клиническое значение антибиотикорезистентности



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В проспективном исследовании 2124 случаев бактериемии было установлено, что комбинированная терапия беталактамами и аминогликозидами не проявляла преимуществ в сравнении с монотерапией беталактамами, исключением были случаи инфекций на фоне нейтропении и инфекций, вызванных Pa [67].

Таким образом, следует признать, что при инфекциях, вызванных Pa, комбинированная терапия, вероятно, предпочтительнее монотерапии, исключение могут составить карбапенемные антибиотики (в первую очередь, меропенем, как обладающий наибольшей активностью). Однако повсеместно наблюдаемое нарастание частоты устойчивости Pa к карбапенемам требует взвешенного подхода к их назначению. Эти антибиотики целесообразно резервировать для эмпирической терапии тяжелых и крайне тяжелых инфекций, при наличии подозрений о их псевдомонадной этиологии, либо для случаев выделения микроорганизмов, устойчивых к антибиотикам других групп. Следует иметь в виду, что длительное лечение тяжелых Ра-инфекций антибиотиками разных групп может привести к формированию штаммов микроорганизма, устойчивых ко всем известным антипсевдомонадным препаратам [68].

В целом, хотя определенный прогресс в антибактериальной терапии тяжелых госпитальных инфекций, вызванных Pa, очевиден, частота неудач остается крайне высокой. Складывается впечатление, что современные представления о патогенезе этой патологии не учитывают какие-то существенные особенности, возможно, что микроорганизм обладает еще не обнаруженными факторами вирулентности, которые в будущем могут служить мишенями специфической терапии.

АНТИБИОТИКИ И ХИМИОТЕРАПИЯ, 1999-N3, стр. 25-34.

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