Epidemiology of infections caused by polymyxin-resistant pathogens
Epidemiology of infections caused by polymyxin-resistant pathogens
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DOI：
10.1016/j.ijantimicag.2016.09.025
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发表时间：
2016-12-01
影响因子：
10.8
通讯作者：
Giamarellou, Helen
中科院分区：
文献类型：
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作者：
Giamarellou, Helen
面对产碳青霉烯酶的革兰氏阴性病原体的风暴，从而面临无法治愈的感染的威胁，医学界恢复了粘菌素。重新引入后不久，尽管对粘菌素的耐药性至少在大肠杆菌中是罕见的，但2004年希腊报告了产金属β-内酰胺酶肺炎克雷伯菌菌株中染色体介导的粘菌素耐药性。随后的研究显示，意大利（38%）和希腊（26%）的优势最高，粘菌素耐药（Col-R）菌株经常携带碳青霉烯酶。另一方面，Col-R鲍曼不动杆菌的国际流行率各不相同，主要分布在南欧和东南亚，意大利和希腊的流行率超过80%。在动物和人类中，风险因素主要是导致过度消耗粘菌素的选择性压力。2015年11月，中国报告了mcr-1基因导致的质粒介导的粘菌素耐药性，主要发生在社区来源的大肠杆菌中。大肠杆菌菌株。截至2016年9月1日，在全球35个国家的牲畜/零售肉类和人类来源中分别检测到mcr-1基因，分别来自29个和22个国家。在动物中大量使用多粘菌素被认为是mcr-1基因的储存者。因此，必须：（i）禁止多粘菌素作为生长促进剂和用于动物预防;（ii）在医院进行靶向监测和分子流行病学;（iii）严格隔离携带mcr-1和碳青霉烯酶基因的分离株感染的携带者或患者;（iv）根据准确的粘菌素最低抑菌浓度（MIC）测定结果确定药敏性;及（v）在医院审核黏菌素的合理使用。(C)2016 Elsevier B. V.和国际化疗学会。All rights reserved.
Confronting the storm of carbapenemase-producing Gram-negative pathogens and thus facing the threat of untreatable infections, the medical community revived colistin. Not long since its re-introduction and despite the fact that resistance to colistin at least in Escherichia coli is rare, chromosomally-mediated colistin resistance in metallo-beta-lactamase-producing Klebsiella pneumoniae strains was reported in 2004 from Greece. Subsequent studies revealed the highest predominance in Italy (38%) and Greece (26%), with colistin-resistant (Col-R) strains frequently carrying a carbapenemase. On the other hand, the international prevalence of Col-R Acinetobacter baumannii varied, predominantly in Southern Europe and Southeast Asia, with rates exceeding 80% in Italy and Greece. Risk factors have mainly incriminated the selective pressure of excess consumption of colistin both in animals and humans. In November 2015, emergence of plasmid-mediated colistin resistance due to the mcr-1 gene was reported from China, mostly in community-derived E. coli strains. As of 1 September 2016, the mcr-1 gene was detected in 35 countries worldwide in livestock/retail meat and in human sources from 29 and 22 countries, respectively. Heavy usage of polymyxins in animals has been incriminated as the reservoir of the mcr-1 gene. Therefore, it is imperative that: (i) polymyxins are banned as growth promoters and for prophylaxis in animals; (ii) targeted surveillance plus molecular epidemiology is performed in hospitals; (iii) carriers or patients infected with isolates harbouring both mcr-1 and carbapenemase genes are strictly isolated; (iv) susceptibilities are based on exact colistin minimum inhibitory concentration (MIC) determination; and (v) rational use of colistin is audited in hospitals. (C) 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.