Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future.
Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future.
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DOI：
10.3201/eid0402.980211
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发表时间：
1998-04
影响因子：
11.8
通讯作者：
中科院分区：
文献类型：
--
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肠球菌是医院内菌血症、手术伤口感染和尿路感染的主要原因，对许多甚至所有的标准治疗方法都产生了抗药性。新的快速监测方法突显了在物种一级检查肠球菌分离株的重要性。大多数肠球菌感染是由粪肠球菌引起的，这种细菌更有可能表现出与公开毒力有关的特征，但目前也更有可能对至少一种有效的抗生素保持敏感性。剩下的感染大多是由粪肠球菌引起的，这是一个几乎没有已知的明显致病特征的物种，但更有可能对最后的抗生素产生抗药性。有效控制多重耐药肠球菌将需要1)更好地了解肠球菌、医院环境和人类之间的相互作用，2)谨慎使用抗生素，3)在医院和其他患者护理环境中更好地接触隔离，以及4)改进监测。同样重要的是，在寻找更多药物方面重新焕发活力，同时演变出不太容易受到药物引进和耐药性循环影响的新治疗范例。
Enterococci, leading causes of nosocomial bacteremia, surgical wound infection, and urinary tract infection, are becoming resistant to many and sometimes all standard therapies. New rapid surveillance methods are highlighting the importance of examining enterococcal isolates at the species level. Most enterococcal infections are caused by Enterococcus faecalis, which are more likely to express traits related to overt virulence but--for the moment--also more likely to retain sensitivity to at least one effective antibiotic. The remaining infections are mostly caused by E. faecium, a species virtually devoid of known overt pathogenic traits but more likely to be resistant to even antibiotics of last resort. Effective control of multiple-drug resistant enterococci will require 1) better understanding of the interaction between enterococci, the hospital environment, and humans, 2) prudent antibiotic use, 3) better contact isolation in hospitals and other patient care environments, and 4) improved surveillance. Equally important is renewed vigor in the search for additional drugs, accompanied by the evolution of new therapeutic paradigms less vulnerable to the cycle of drug introduction and drug resistance.