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抗菌药物耐药性的问题与困境

Problems and dilemmas of antimicrobial resistance.

作者信息

Murray B E

机构信息

Department of Internal Medicine, University of Texas Medical School, Houston 77030.

出版信息

Pharmacotherapy. 1992;12(6 Pt 2):86S-93S.

PMID:1480504
Abstract

An important obstacle to the long-term efficacy of an antimicrobial agent is the appearance and spread of resistance to the agent. The fact that many antimicrobials are produced by microorganisms in nature may provide long-term selective pressure for the emergence of resistance in antibiotic-producing as well as -nonproducing organisms. Indeed, the rapidity with which many resistances have appeared after the introduction of a new antibiotic suggests that these resistance genes were already present somewhere in nature prior to clinical use. In the hospital setting, the most recent worrisome resistance traits to emerge include plasmid-mediated resistance to imipenem and to third-generation cephalosporins among nosocomial gram-negative bacteria, and the acquisition of resistance to vancomycin by enterococci. Methicillin-resistant staphylococci continue to be a problem and are increasingly resistant to numerous other agents such as rifampin and the newer fluoroquinolones. The most important resistances seen in community-acquired organisms include beta-lactam resistance in pneumococci and combined ampicillin and chloramphenicol resistance in Haemophilus influenzae. Shigellae resistant to essentially all commonly used oral agents are also a problem, particularly in developing countries. No end is in sight to the problem of antimicrobial resistance, and thus new strategies to prevent infections and control resistant organisms continue to be necessary.

摘要

抗菌剂长期疗效的一个重要障碍是对该药剂耐药性的出现和传播。许多抗菌剂是由自然界中的微生物产生的,这一事实可能会对产生抗生素的生物体以及不产生抗生素的生物体中耐药性的出现形成长期的选择压力。事实上,在引入一种新抗生素后,许多耐药性迅速出现,这表明这些耐药基因在临床使用之前就已存在于自然界的某个地方。在医院环境中,最近出现的最令人担忧的耐药特性包括医院内革兰氏阴性菌中质粒介导的对亚胺培南和第三代头孢菌素的耐药性,以及肠球菌对万古霉素的耐药性获得。耐甲氧西林葡萄球菌仍然是一个问题,并且对许多其他药剂(如利福平及新型氟喹诺酮类药物)的耐药性日益增强。在社区获得性生物体中看到的最重要的耐药性包括肺炎球菌中的β-内酰胺耐药性以及流感嗜血杆菌中对氨苄西林和氯霉素的联合耐药性。对基本上所有常用口服药剂均耐药的志贺氏菌也是一个问题,尤其是在发展中国家。抗菌耐药性问题看不到尽头,因此预防感染和控制耐药生物体的新策略仍然是必要的。

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