Tenover F C
Nosocomial Pathogens Laboratory Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Clin Infect Dis. 2001 Sep 15;33 Suppl 3:S108-15. doi: 10.1086/321834.
Resistance to antimicrobial agents is emerging in a wide variety of nosocomial and community-acquired pathogens. The emergence and spread of multiply resistant organisms represent the convergence of a variety of factors that include mutations in common resistance genes that extend their spectrum of activity, the exchange of genetic information among microorganisms, the evolution of selective pressures in hospitals and communities that facilitate the development and spread of resistant organisms, the proliferation and spread of multiply resistant clones of bacteria, and the inability of some laboratory testing methods to detect emerging resistance phenotypes. Twenty years ago, bacteria that were resistant to antimicrobial agents were easy to detect in the laboratory because the concentration of drug required to inhibit their growth was usually quite high and distinctly different from that of susceptible strains. Newer mechanisms of resistance, however, often result in much more subtle shifts in bacterial population distributions. Perhaps the most difficult phenotypes to detect, as shown in several proficiency testing surveys, are decreased susceptibility to beta-lactams in pneumococci and decreased susceptibility to vancomycin in staphylococci. In summary, emerging resistance has required adaptations and modifications of laboratory diagnostic techniques, empiric anti-infective therapy for such diseases as bacterial meningitis, and infection control measures in health care facilities of all kinds. Judicious use is imperative if we are to preserve our arsenal of antimicrobial agents into the next decade.
抗菌药物耐药性正在多种医院获得性和社区获得性病原体中出现。多重耐药菌的出现和传播是多种因素共同作用的结果，这些因素包括常见耐药基因的突变使其活性谱扩大、微生物之间的遗传信息交换、医院和社区中选择性压力的演变促进了耐药菌的产生和传播、多重耐药细菌克隆的增殖和传播，以及一些实验室检测方法无法检测出新出现的耐药表型。二十年前，在实验室中很容易检测出对抗菌药物耐药的细菌，因为抑制其生长所需的药物浓度通常相当高，且与敏感菌株明显不同。然而，新的耐药机制往往会导致细菌群体分布发生更为细微的变化。正如几项能力验证调查所示，最难检测的表型可能是肺炎球菌对β-内酰胺类药物敏感性降低以及葡萄球菌对万古霉素敏感性降低。总之，新出现的耐药性要求对实验室诊断技术进行调整和改进，对细菌性脑膜炎等疾病采用经验性抗感染治疗，并在各类医疗机构中采取感染控制措施。如果我们要在下一个十年保留我们的抗菌药物库，明智地使用抗菌药物势在必行。
