Donskey Curtis J
Infectious Diseases Section, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA.
Clin Infect Dis. 2006 Sep 1;43 Suppl 2:S62-9. doi: 10.1086/504481.
The intestinal tract provides an important reservoir for antibiotic-resistant gram-negative bacilli, including Enterobacteriaceae species, Pseudomonas aeruginosa, and Acinetobacter baumannii. Selective pressure exerted by antibiotics plays a crucial role in the emergence and dissemination of these pathogens. Many classes of antibiotics may promote intestinal colonization by health care-associated gram-negative bacilli, because the organisms are often multidrug resistant. Antibiotics may inhibit colonization by gram-negative pathogens that remain susceptible, but the benefits of this effect are often limited because of the emergence of resistance. Antibiotic formulary alterations and standard infection control measures have been effective in controlling outbreaks of colonization and infection with antibiotic-resistant gram-negative pathogens. Additional research is needed to clarify the role of strategies such as selective decontamination of the digestive tract and decontamination of environmental surfaces and of patients' skin and wounds.
肠道是耐抗生素革兰氏阴性杆菌的重要储存库，包括肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌。抗生素施加的选择压力在这些病原体的出现和传播中起着关键作用。许多类抗生素可能会促进医疗保健相关革兰氏阴性杆菌在肠道的定植，因为这些微生物往往具有多重耐药性。抗生素可能会抑制仍敏感的革兰氏阴性病原体的定植，但由于耐药性的出现，这种效果的益处往往有限。抗生素处方的改变和标准感染控制措施在控制耐抗生素革兰氏阴性病原体的定植和感染暴发方面已取得成效。还需要进一步研究以阐明诸如消化道选择性去污、环境表面以及患者皮肤和伤口去污等策略的作用。
