Emerging mechanisms of fluoroquinolone resistance.
Emerging mechanisms of fluoroquinolone resistance.
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DOI：
10.3201/eid0702.010239
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发表时间：
2001-03
影响因子：
11.8
通讯作者：
Hooper DC
中科院分区：
文献类型：
--
作者：
Hooper DC
氟喹诺酮类药物的广泛使用之后出现了耐药性，这主要是由于编码药物靶酶、DNA促旋酶和拓扑异构酶IV亚基的基因中的染色体突变，以及影响外膜和多药耐药外排系统中扩散通道表达的基因中的染色体突变。耐药性首先出现在单一突变足以引起临床重要耐药性水平的物种中（例如，金黄色葡萄球菌和铜绿假单胞菌）。然而，随后，在空肠弯曲杆菌、大肠杆菌和淋病奈瑟菌等细菌中出现了耐药性，其中需要多个突变才能产生临床上重要的耐药性。在这种情况下，动物吸毒和人际传播的其他流行病学因素似乎也起了作用。肺炎链球菌的耐药性目前较低，需要密切监测，因为氟喹诺酮类药物更广泛地用于治疗呼吸道感染。
Broad use of fluoroquinolones has been followed by emergence of resistance, which has been due mainly to chromosomal mutations in genes encoding the subunits of the drugs' target enzymes, DNA gyrase and topoisomerase IV, and in genes that affect the expression of diffusion channels in the outer membrane and multidrug-resistance efflux systems. Resistance emerged first in species in which single mutations were sufficient to cause clinically important levels of resistance (e.g., Staphylococcus aureus and Pseudomonas aeruginosa). Subsequently, however, resistance has emerged in bacteria such as Campylobacter jejuni, Escherichia coli, and Neisseria gonorrhoeae, in which multiple mutations are required to generate clinically important resistance. In these circumstances, the additional epidemiologic factors of drug use in animals and human-to-human spread appear to have contributed. Resistance in Streptococcus pneumoniae, which is currently low, will require close monitoring as fluoroquinolones are used more extensively for treating respiratory tract infections.
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