Advances in the therapy of bacterial bloodstream infections.

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Advances in the therapy of bacterial bloodstream infections.

Clin Microbiol Infect. 2019 Nov 13;:

Authors: Giannella M, Bartoletti M, Gatti M, Viale P

Abstract
BACKGROUND: Advances in the diagnostic and therapeutic management of patients with bloodstream infection (BSI) have been achieved in the last years, improving clinical outcome. However, mortality associated with some pathogens, such as Staphylococcus aureus and Enterococcus spp., is still high. In addition, the spread of antibiotic resistance, mainly among gram-negative bacteria, reduces treatment options in some circumstances. Therefore, interest in new drugs, combination regimens, and optimal dosing schedules is rising.
OBJECTIVES: Our aim is to summarize the current evidence on available antibiotic regimens for patients with bacterial BSI, focusing on drug choice, combination regimens and optimal dosing schedules. We selected bacteria difficult to manage due to virulence factors (i.e. methicillin-susceptible Staphylococcus aureus), tolerance to antibiotic activity (i.e. Enterococcus faecalis), and/or susceptibility patterns (i.e. methicillin-resistant S. aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii).
SOURCES: MEDLINE search with English language and publication in the last 5 years as limits.
CONTENT AND IMPLICATIONS: The literature gaps on the use of new drugs, the uncertainties regarding the use of combination regimens, and the need of optimizing dosing schedules in some circumstances (e.g. augmented renal clearance, renal replacement therapy, high inoculum BSI sources, and isolation of bacteria showing high minimum inhibitory concentrations) have been revised.

PMID: 31733377 [PubMed - as supplied by publisher]