Multidrug-Resistant Bacteria in the Community: Trends and Lessons Learned.
Multidrug-Resistant Bacteria in the Community: Trends and Lessons Learned.
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DOI：
10.1016/j.idc.2016.02.004
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发表时间：
2016-06
影响因子：
4.4
通讯作者：
Paterson DL
中科院分区：
文献类型：
--
作者：
van Duin D;Paterson DL
多药耐药（MDR）细菌是当前对公共卫生最重要的威胁之一。通常，MDR细菌与医院感染有关。然而，一些MDR细菌已经成为社区获得性感染的非常普遍的原因。MDR细菌向社区的传播是一个关键的发展，与发病率、死亡率、医疗费用和抗生素使用增加有关。与MDR细菌社区传播相关的因素重叠，但与医院内传播相关的因素不同。社区相关（CA）MDR细菌具有抗生素耐药表型，在没有医院或疗养院通常观察到的抗生素压力的情况下，该表型是稳定的。这一规则的一个例外可能是那些CA-MDR细菌，其流行是由食物链中抗生素的存在驱动的。此外，在其他方面健康的宿主的定殖是CA-MDR细菌的共同特征。然而，在被特定CA-MDR细菌定殖的受试者中仍然可能存在轻微的免疫缺陷。耐甲氧西林表皮葡萄金黄色葡萄球菌（MRSA）是最普遍的CA-MDR细菌。CA-MRSA对发病率和死亡率的影响也最大。即将出现的主要威胁是肠杆菌科。在社区中遇到的肠杆菌科细菌产生超广谱β-内酰胺酶的情况越来越普遍。非常值得关注的是CA-肠杆菌科中获得碳青霉烯酶基因的可能性。预防MDR细菌的进一步社区传播至关重要，需要所有利益相关者参与的多学科方法。
Multidrug resistant (MDR) bacteria are one of the most important current threats to public health. Typically, MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become quite prevalent causes of community-acquired infections. The spread of MDR bacteria into the community is a crucial development, and is associated with increased morbidity, mortality, healthcare costs and antibiotic use. Factors associated with community dissemination of MDR bacteria overlap but are distinct from those associated with nosocomial spread. Community-associated (CA) MDR bacteria have an antibiotic resistance phenotype that is stable in the absence of antibiotic pressure of the type normally observed in hospitals or nursing homes. An exception to this rule may be those CA-MDR bacteria, of which the prevalence is driven by the presence of antibiotics in the food chain. Additionally, the colonization of otherwise healthy hosts is a common characteristic of CA-MDR bacteria. However, subtle immune deficiencies may still be present in the subjects colonized with specific CA-MDR bacteria. Methicillin-resistant S. aureus (MRSA) is the most prevalent of CA-MDR bacteria. CA-MRSA also has the greatest impact on morbidity and mortality. The main threat on the horizon is represented by Enterobacteriaceae. The production of extended spectrum β-lactamases in Enterobacteriaceae encountered in the community is becoming increasingly prevalent. Of great concern is the potential for the acquisition of carbapenemase genes in CA-Enterobacteriaceae. Prevention of further community spread of MDR bacteria is of the utmost importance, and will require a multi-disciplinary approach involving all stakeholders.