Livermore David M, Woodford Neil
Antibiotic Resistance Monitoring and Reference Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, NW9 5EQ, UK.
Trends Microbiol. 2006 Sep;14(9):413-20. doi: 10.1016/j.tim.2006.07.008. Epub 2006 Jul 31.
Over the past 60 years, the use of successive generations of beta-lactam antibiotics has selected successive generations of beta-lactamase enzymes, each more potent than the last. Currently, rising problems include CTX-M extended-spectrum beta-lactamases (ESBLs), plasmid-mediated AmpC beta-lactamases and KPC carbapenemases in Enterobacteriaceae, while OXA- and metallo- carbapenemases are of growing importance in Acinetobacter spp. and (less so) in other non-fermenters. Escherichia coli isolates with CTX-M ESBLs are spreading multiresistance in the community and in hospitals, while carbapenemase-producing Acinetobacter spp., mostly from intensive care, are among the most multiresistant nosocomial bacteria known and are often susceptible only to polymyxins and, potentially, tigecycline. This review discusses the epidemiology and microbiology of these resistance problems, along with possible solutions.
在过去60年里，历代β-内酰胺类抗生素的使用筛选出了历代β-内酰胺酶，每一代的效力都比上一代更强。目前，不断出现的问题包括肠杆菌科细菌中的CTX-M超广谱β-内酰胺酶（ESBLs）、质粒介导的AmpCβ-内酰胺酶和KPC碳青霉烯酶，而OXA-和金属碳青霉烯酶在不动杆菌属中日益重要，在其他非发酵菌中重要性稍低。携带CTX-M ESBLs的大肠埃希菌分离株正在社区和医院传播多重耐药性，而产碳青霉烯酶的不动杆菌属细菌大多来自重症监护病房，是已知的多重耐药性最强的医院感染细菌之一，通常仅对多粘菌素以及可能的替加环素敏感。本文综述讨论了这些耐药问题的流行病学和微生物学，以及可能的解决办法。
