RESUMO
Antibiotic resistance has become a major medical problem of our time. In 2015, the World Health Organisation (WHO) endorsed a global action plan in response. One of the main axes of this plan has been the sustained development of new antimicrobials. Despite its challenges, over half a dozen new substances have become clinically available in the last decade. Here, we review a selection of these novel antimicrobial and their applications and discuss their possible use in the clinical setting.
La problématique de la résistance aux antibiotiques a poussé l'Organisation mondiale de la santé (OMS) à élaborer en mai 2015 un plan d'action. Parmi les points centraux de ce plan, l'OMS insiste sur la nécessité de développer de nouveaux antibiotiques. Malgré la difficulté de cette entreprise, près d'une dizaine de nouvelles substances ont fait leur entrée en clinique pendant ces dernières années. Dans ce contexte, nous passons en revue les avancées principales de cette dernière décennie avec un regard critique sur la possibilité que ces nouvelles substances s'établissent dans notre quotidien clinique.
Assuntos
Antibacterianos , Desenvolvimento de Medicamentos , Descoberta de Drogas , Antibacterianos/provisão & distribuição , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , HumanosRESUMO
INTRODUCTION: Candida species are the leading cause of invasive fungal infections in hospitalised patients and are the fourth most common isolates recovered from patients with bloodstream infection. Few data exist on risk factors for candidemia in non-ICU patients. We performed a population-based case-control study to evaluate the main predictors for candidemia in non-ICU patients. METHODS AND FINDINGS: We included all non-neutropenic, non-critically ill and non-surgical adult patients with candidemia between January 2010 and June 2014. Patients with positive, non-candidal blood culture obtained at the same day (±2 days) were selected as controls. Cases and controls were matched according to hospital ward and clinical characteristics. Risk factors for candidemia were identified through a logistic regression. We included 56 candidemic and 512 bacteriemic non-candidemic patients. Most of candidemic patients (52) had received antibiotics prior to candidemia. Among them, the 30-day mortality rate was 34% (19/56). Multivariate analysis identified male sex, prior use of steroids, prior use of antibiotics, total parenteral nutrition and urinary catheterisation as independent predictors of candidemia. To develop the CaMed score, we rounded up weights of different risk factors as follows; total parenteral nutrition (+2), prior antibiotic therapy (+5), each of the other risk factors (+1). A score ≥ 7 identified patients at high risk of candidemia (P < 0.001; RR 29.805; CI 95% 10.652-83.397; sensitivity 79.2, specificity 82.6%, Youden index 0,62). CONCLUSIONS: Our set of easy independent predictors of candidemia in non-neutropenic, non-ICU, non-surgical patients provide a rationale for early initiation of antifungals and could reduce candidemia-related mortality.