Travers Karin, Barza Michael
Alliance for the Prudent Use of Antibiotics, Boston, MA, USA.
Clin Infect Dis. 2002 Jun 1;34 Suppl 3:S131-4. doi: 10.1086/340251.
Antimicrobial resistance can have 2 effects on the outcome of infection: there can be an accompanying change in the virulence of the organism, and there can be a poorer response to treatment because of the empiric choice of an antimicrobial to which the organism is resistant. We have reviewed published studies relating antimicrobial resistance to the outcomes of infection caused by enteric pathogens. The data for Salmonella and Campylobacter infections suggest that antimicrobial-resistant strains are somewhat more virulent than susceptible strains-that is, they cause more prolonged or more severe illness than do antimicrobial-susceptible strains. However, not all studies corrected for possible differences in age and underlying diseases between patients infected by antimicrobial-resistant and -susceptible strains of Salmonella. Two studies of Campylobacter infection suggest that poorer outcomes with antimicrobial-resistant pathogens could be related to the initial choice of an ineffective antimicrobial for treatment. Estimates from various sources indicate that fluoroquinolone resistance, likely acquired from the administration of antimicrobials to food animals, leads to >400,000 excess days of diarrhea in the United States per year compared with the duration that would occur if all of the isolates were susceptible. Antimicrobial resistance also could account for an extra 8677 days of hospitalization for nontyphoidal salmonellosis, mainly arising from food animals.
微生物的毒力可能会随之改变，且由于经验性选择了微生物耐药的抗菌药物，治疗反应可能会更差。我们回顾了已发表的关于抗菌药物耐药性与肠道病原体所致感染结局之间关系的研究。沙门氏菌和弯曲杆菌感染的数据表明，耐药菌株的毒力略强于敏感菌株，也就是说，与抗菌药物敏感菌株相比，它们导致的疾病持续时间更长或病情更严重。然而，并非所有研究都对感染抗菌药物耐药和敏感沙门氏菌菌株的患者之间可能存在的年龄和基础疾病差异进行了校正。两项关于弯曲杆菌感染的研究表明，抗菌药物耐药病原体导致的较差结局可能与最初选择无效的抗菌药物进行治疗有关。来自各种来源的估计表明，在美国，氟喹诺酮耐药性可能源于对食用动物使用抗菌药物，与所有分离株均敏感的情况下相比，每年导致腹泻天数增加超过40万天。抗菌药物耐药性还可能导致非伤寒沙门氏菌病额外增加8677天的住院时间，主要源于食用动物。
