John J F, Rice L B
Division of Allergy, Immunology, and Infectious Diseases, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA.
Infect Control Hosp Epidemiol. 2000 Jan;21(1 Suppl):S22-31. doi: 10.1086/503170.
Cycling of currently available antibiotics to reduce resistance is an attractive concept. For cycling strategies to be successful, their implementation must have a demonstrable impact on the prevalence of resistance determinants already dispersed throughout the hospital and associated healthcare facilities. While antibiotic use in hospitals clearly constitutes a stimulus for the emergence of resistance, it is by no means the only important factor. The incorporation of resistance determinants into potentially stable genetic structures, including bacteriophages, plasmids, transposons, and the more newly discovered movable elements termed integrons and gene cassettes, forces some degree of skepticism about the potential for such strategies in institutions where resistance determinants are already prevalent. In particular, the expanding role of integrons may pose an ultimate threat to formulary manipulations such as cycling. Despite these concerns, the crisis posed by antimicrobial resistance warrants investigation of any strategy with the potential for reducing the prevalence of resistance. Over the next decade, new studies with carefully designed outcomes should determine the utility of antibiotic cycling as one control measure for nosocomial resistance.
轮换使用现有抗生素以降低耐药性是一个颇具吸引力的概念。要使轮换策略取得成功，其实施必须对已在整个医院及相关医疗设施中传播的耐药决定因素的流行情况产生明显影响。虽然医院内抗生素的使用显然是耐药性产生的一个刺激因素，但绝不是唯一的重要因素。耐药决定因素整合到潜在稳定的遗传结构中，包括噬菌体、质粒、转座子以及最近发现的称为整合子和基因盒的可移动元件，这使得人们对在耐药决定因素已经普遍存在的机构中实施此类策略的潜力产生了一定程度的怀疑。特别是，整合子作用的不断扩大可能对诸如轮换用药等处方操作构成最终威胁。尽管存在这些担忧，但抗菌药物耐药性引发的危机仍需要对任何有可能降低耐药性流行率的策略进行调查。在接下来的十年里，精心设计结果的新研究应能确定抗生素轮换作为一种控制医院耐药性的措施的效用。
