Current epidemiology and growing resistance of gram-negative pathogens.
Current epidemiology and growing resistance of gram-negative pathogens.
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DOI：
10.3904/kjim.2012.27.2.128
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发表时间：
2012-06
期刊：
影响因子：
--
通讯作者：
Livermore DM
中科院分区：
文献类型：
--
作者：
Livermore DM
在20世纪80年代，革兰氏阴性病原体似乎已经被氧亚氨基头孢菌素类、碳青霉烯类和氟喹诺酮类击败。然而，这些病原体通过其膜组织（促进抗生素的排斥和外排）以及招募、转移和修饰耐药基因表达的显著倾向进行了反击，包括超广谱β-内酰胺酶（ESBLs）、碳青霉烯酶、氨基糖苷类阻断16 S rRNA甲基化酶，甚至氨基糖苷类修饰酶的喹诺酮修饰变体。革兰氏阴性分离株-发酵菌和非发酵菌-仅对粘菌素敏感，更重要的是，磷霉素和替加环素，包括在韩国，出现频率越来越高。一些ESBLs和碳青霉烯酶已与具有巨大流行潜力的菌株相关，在各国和各大洲传播;例如大肠埃希菌序列型（ST）131与CTX-M-15 ESBL和肺炎克雷伯菌ST 258与KPC碳青霉烯酶。这两种高风险的血统都已经到达韩国。在其他情况下，特别是新德里金属碳青霉烯酶，相关基因由混杂质粒携带，这些质粒很容易在菌株和物种之间转移。除非加强抗生素管理，加速微生物诊断，重振抗生素开发，否则世纪的抗生素革命将有真实的前景。
In the 1980s, Gram-negative pathogens appeared to have been beaten by oxyimino-cephalosporins, carbapenems, and fluoroquinolones. Yet these pathogens have fought back, aided by their membrane organization, which promotes the exclusion and efflux of antibiotics, and by a remarkable propensity to recruit, transfer, and modify the expression of resistance genes, including those for extended-spectrum β-lactamases (ESBLs), carbapenemases, aminoglycoside-blocking 16S rRNA methylases, and even a quinolone-modifying variant of an aminoglycoside-modifying enzyme. Gram-negative isolates -both fermenters and non-fermenters-susceptible only to colistin and, more variably, fosfomycin and tigecycline, are encountered with increasing frequency, including in Korea. Some ESBLs and carbapenemases have become associated with strains that have great epidemic potential, spreading across countries and continents; examples include Escherichia coli sequence type (ST)131 with CTX-M-15 ESBL and Klebsiella pneumoniae ST258 with KPC carbapenemases. Both of these high-risk lineages have reached Korea. In other cases, notably New Delhi Metallo carbapenemase, the relevant gene is carried by promiscuous plasmids that readily transfer among strains and species. Unless antibiotic stewardship is reinforced, microbiological diagnosis accelerated, and antibiotic development reinvigorated, there is a real prospect that the antibiotic revolution of the 20th century will crumble.
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