The changing epidemiology of resistance
The changing epidemiology of resistance
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DOI：
10.1093/jac/dkp256
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发表时间：
2009-09-01
影响因子：
5.2
通讯作者：
Jones, Annie M.
中科院分区：
文献类型：
--
作者：
Hawkey, Peter M.;Jones, Annie M.
抗生素耐药性现在是一个相互关联的全球性问题。多药耐药（MDR）细菌的成功克隆的扩散是常见的，通常通过人员的移动。在过度使用抗生素的压力下，MDR细菌的局部进化也很重要，水平基因转移提供了基因如B/a（CTX-M）在不同细菌物种和菌株之间传播的手段。β-内酰胺酶的产生是革兰氏阴性菌中常见的耐药机制，新基因的快速传播反映了它们在抗生素使用的选择压力下的进化。现在许多肠杆菌科携带广谱β-内酰胺酶，如CTX-M，具有与不同地理区域相关的特定基因型。这些酶的传播已经损害了许多β-内酰胺类的临床效用，并且随着bla（KPC）等基因的传播，碳青霉烯类在未来可能会越来越受到损害。高水平的氟喹诺酮耐药（主要由gyrA突变引起）也已被证明与CTX-M和CMY型酶相关，通常是由于氨基糖苷类失活酶AAC-6（1）-lb-cr和qnr基因（其赋予低水平的耐药）的接合质粒上的共携带，从而允许在宿主菌株中容易地选择gyrA突变体。革兰氏阳性菌的耐药性也广泛分布并不断增加，社区相关耐甲氧西林金黄色葡萄球菌（MRSA）的出现模糊了医院和社区菌株之间的区别。抗生素的使用和环境因素都在耐药性的出现和传播中发挥作用。本文综述了MDR细菌在全球传播的一些新机制和最新趋势。
Antibiotic resistance is now a linked global problem. Dispersion of successful clones of multidrug resistant (MDR) bacteria is common, often via the movement of people. Local evolution of MDR bacteria is also important under the pressure of excessive antibiotic use, with horizontal gene transfer providing the means by which genes such as b/a(CTX-M) spread amongst different bacterial species and strains. beta-Lactamase production is a common resistance mechanism in Gram-negative bacteria, and the rapid dissemination of novel genes reflects their evolution under the selective pressure of antibiotic usage. Many Enterobacteriaceae now carry broad-spectrum beta-lactamases such as CTX-M, with particular genotypes associated with different geographical regions. The spread of these enzymes has compromised the clinical utility of a number of beta-lactam classes and with the spread of genes such as bla(KPC), carbapenems may be increasingly compromised in the future. High-level fluoroquinolone resistance (mainly caused by gyrA mutations) has also been shown to be associated with CTX-M and CMY-type enzymes, commonly due to co-carriage on conjugative plasmids of the gene for the aminoglycoside-inactivating enzyme AAC-6(1)-lb-cr and qnr genes (which confer low-level resistance), allowing the easy selection of gyrA mutants in the host strain. Resistance in Gram-positive bacteria is also widely distributed and increasing, with the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) blurring the distinction between hospital and community strains. Antibiotic use and environmental factors all have a role in the emergence and spread of resistance. This article reviews some of the new mechanisms and recent trends in the global spread of MDR bacteria.