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Principe L, Lupia T, Andriani L, Campanile F, Carcione D, Corcione S, De Rosa FG, Luzzati R, Stroffolini G, Steyde M, Decorti G, Di Bella S. Microbiological, Clinical, and PK/PD Features of the New Anti-Gram-Negative Antibiotics: β-Lactam/β-Lactamase Inhibitors in Combination and Cefiderocol—An All-Inclusive Guide for Clinicians. Pharmaceuticals (Basel) 2022; 15:ph15040463. [PMID: 35455461 PMCID: PMC9028825 DOI: 10.3390/ph15040463] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
Bacterial resistance mechanisms are continuously and rapidly evolving. This is particularly true for Gram-negative bacteria. Over the last decade, the strategy to develop new β-lactam/β-lactamase inhibitors (BLs/BLIs) combinations has paid off and results from phase 3 and real-world studies are becoming available for several compounds. Cefiderocol warrants a separate discussion for its peculiar mechanism of action. Considering the complexity of summarizing and integrating the emerging literature data of clinical outcomes, microbiological mechanisms, and pharmacokinetic/pharmacodynamic properties of the new BL/BLI and cefiderocol, we aimed to provide an overview of data on the following compounds: aztreonam/avibactam, cefepime/enmetazobactam, cefepime/taniborbactam, cefepime/zidebactam, cefiderocol, ceftaroline/avibactam, ceftolozane/tazobactam, ceftazidime/avibactam, imipenem/relebactam, meropenem/nacubactam and meropenem/vaborbactam. Each compound is described in a dedicated section by experts in infectious diseases, microbiology, and pharmacology, with tables providing at-a-glance information.
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Affiliation(s)
- Luigi Principe
- Clinical Pathology and Microbiology Unit, “San Giovanni di Dio” Hospital, I-88900 Crotone, Italy;
| | - Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia Hospital, I-14100 Asti, Italy; (T.L.); (F.G.D.R.)
| | - Lilia Andriani
- Clinical Pathology and Microbiology Unit, Hospital of Sondrio, I-23100 Sondrio, Italy;
| | - Floriana Campanile
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, I-95123 Catania, Italy;
| | - Davide Carcione
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, I-20132 Milan, Italy;
| | - Silvia Corcione
- Infectious diseases Unit, Department of Medical Sciences, University of Torino, I-10124 Torino, Italy; (S.C.); (G.S.)
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia Hospital, I-14100 Asti, Italy; (T.L.); (F.G.D.R.)
- Infectious diseases Unit, Department of Medical Sciences, University of Torino, I-10124 Torino, Italy; (S.C.); (G.S.)
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, I-34149 Trieste, Italy; (R.L.); (M.S.); (S.D.B.)
| | - Giacomo Stroffolini
- Infectious diseases Unit, Department of Medical Sciences, University of Torino, I-10124 Torino, Italy; (S.C.); (G.S.)
| | - Marina Steyde
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, I-34149 Trieste, Italy; (R.L.); (M.S.); (S.D.B.)
| | - Giuliana Decorti
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, I-34149 Trieste, Italy; (R.L.); (M.S.); (S.D.B.)
- Institute for Maternal and Child Health–IRCCS Burlo Garofolo, I-34137 Trieste, Italy
- Correspondence: ; Tel.: +39 40-378-5362
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, I-34149 Trieste, Italy; (R.L.); (M.S.); (S.D.B.)
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Abstract
With advances in abdominal surgery and the management of major trauma, complex abdominal wall defects have become the new surgical disease, and the need for abdominal wall reconstruction has increased dramatically. Subsequently, how to reconstruct these large defects has become a new surgical question. While most surgeons use native abdominal wall whenever possible, evidence suggests that synthetic or biologic mesh needs to be added to large ventral hernia repairs. One particular group of patients who exemplify "complex" are those with contaminated wounds, enterocutaneous fistulas, enteroatmospheric fistulas, and/or stoma(s), where synthetic mesh is to be avoided if at all possible. Most recently, biologic mesh has become the new standard in high-risk patients with contaminated and dirty-infected wounds. While biologic mesh is the most common tissue engineered used in this field of surgery, level I evidence is needed on its indication and long-term outcomes. Various techniques for reconstructing the abdominal wall have been described, however the long-term outcomes for most of these studies, are rarely reported. In this article, I outline current practical approaches to perioperative management and definitive abdominal reconstruction in patients with complex abdominal wall defects, with or without fistulas, as well as those who have lost abdominal domain.
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