Enterococcal infections & antimicrobial resistance.
Enterococcal infections & antimicrobial resistance.
复制标题
肠球菌感染
DOI：
--
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
A. Kapil
中科院分区：
文献类型：
--
作者：
S. Sood;M. Malhotra;B. Das;A. Kapil
肠球菌在传统上被认为是低度致病菌，在过去十年中已成为医院感染的重要原因。虽然已经鉴定了大约12种肠球菌，但只有两种是大多数人类感染的原因，即，粪肠球菌（Enterococcus faecalis）和E.屎室由这些微生物产生的最常见的医院感染是尿路感染（与器械和抗菌素耐药性相关），其次是腹腔内和盆腔感染。它们还引起手术伤口感染、菌血症、心内膜炎、新生儿败血症和罕见的脑膜炎。这些微生物在医院环境中存活的主要原因是对几种常用抗生素的内在抗性，也许更重要的是，它们通过突变或通过质粒和转座子的转移接受外源遗传物质而获得对所有现有抗生素的抗性的能力。万古霉素耐药肠球菌（VRE）的出现令人担忧，因为一旦建立，就很难控制。此外，耐药基因可能从肠球菌转移到金黄色葡萄球菌，从而对患者安全构成威胁，也对治疗医生构成挑战。这篇综述强调了肠球菌感染谱的变化，沿着它们的地理分布和日益增长的医院重要性。还讨论了抗生素耐药性、致病性和毒力因素的出现，以及目前严重肠球菌感染的预防、控制和治疗方式。
Enterococci have traditionally regarded as low grade pathogens, have emerged as an increasingly important cause of nosocomial infections in the last decade. Although about a dozen enterococcus species have been identified, only two are responsible for the majority of human infections, i.e., Enterococcus faecalis and E. faecium. The most common nosocomial infections produced by these organisms are urinary tract infections (associated with instrumentation and antimicrobial resistance), followed by intra-abdominal and pelvic infections. They also cause surgical wound infections, bacteraemia, endocarditis, neonatal sepsis and rarely meningitis. A major reason why these organisms survive in hospital environment is the intrinsic resistance to several commonly used antibiotics and, perhaps more importantly, their ability to acquire resistance to all currently available antibiotics, either by mutation or by receipt of foreign genetic material through the transfer of plasmids and transposons. The emergence of vancomycin-resistant enterococci (VRE) is a cause of concern, as once established, it is very difficult to control. Moreover, there can be transfer of resistant gene from enterococci to Staphylococcus aureus thereby posing a threat to the patient safety and also challenges for the treating physicians. This review highlights the shifting spectrum of enterococcal infections, along with their geographical distribution and growing nosocomial importance. Emergence of antimicrobial resistance, pathogenicity and virulence factors, current preventive, control and treatment modalities of severe enterococcal infections are also dealt with.