Tenover F C
Antimicrobics Investigation Branch, Centers for Disease Control, Atlanta, Georgia 30333.
Am J Med. 1991 Sep 16;91(3B):76S-81S. doi: 10.1016/0002-9343(91)90347-z.
Nosocomial pathogens frequently are resistant to antimicrobial agents. Although methicillin-resistant strains of Staphylococcus aureus continue to be a major problem in many hospitals, several new types of resistance determinants have been noted among organisms causing hospital-acquired infections. The mechanisms include extended spectrum beta-lactamases in gram-negative bacilli; resistance to beta-lactams, glycopeptides, and high levels of aminoglycosides among enterococci; quinolone resistance in isolates of methicillin-resistant S. aureus; and the spread of multiple resistance genes simultaneously in gram-negative organisms via Tn21-related genetic elements. These novel mechanisms of resistance complicate the treatment of nosocomial infections by limiting the number of effective antimicrobial agents available to the clinician. It is important for infection control practitioners and microbiologists to work together to detect and control the spread of resistant pathogens in the hospital setting.
医院病原体常常对抗菌药物耐药。尽管耐甲氧西林金黄色葡萄球菌菌株在许多医院仍是一个主要问题，但在引起医院获得性感染的病原体中已发现几种新型耐药决定因素。其机制包括革兰氏阴性杆菌中的超广谱β-内酰胺酶；肠球菌对β-内酰胺类、糖肽类和高水平氨基糖苷类的耐药；耐甲氧西林金黄色葡萄球菌分离株中的喹诺酮耐药；以及通过与Tn21相关的遗传元件在革兰氏阴性菌中同时传播多个耐药基因。这些新型耐药机制通过限制临床医生可获得的有效抗菌药物数量，使医院感染的治疗变得复杂。感染控制从业者和微生物学家共同努力检测和控制医院环境中耐药病原体的传播非常重要。
