Falagas Matthew E, Bliziotis Ioannis A
Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece.
Int J Antimicrob Agents. 2007 Jun;29(6):630-6. doi: 10.1016/j.ijantimicag.2006.12.012. Epub 2007 Feb 16.
The evolving problem of antimicrobial resistance in Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae has led to the emergence of clinical isolates susceptible to only one class of antimicrobial agents and eventually to pandrug-resistant (PDR) isolates, i.e. resistant to all available antibiotics. We reviewed the available evidence from laboratory and clinical studies that reported on polymyxin-resistant and/or PDR P. aeruginosa, A. baumannii or K. pneumoniae clinical isolates. Eleven laboratory studies reported on isolates with resistance to polymyxins, three of which (including two surveillance studies) also included data regarding PDR isolates. In addition, two clinical studies (from Central and Southern Europe) reported on the clinical characteristics and outcomes of patients infected with PDR isolates. These data suggest that polymyxin-resistant or PDR P. aeruginosa, A. baumannii and K. pneumoniae clinical isolates are currently relatively rare. However, they have important global public health implications because of the therapeutic problems they pose. The fears for the dawn of a post-antibiotic era appear to be justified, at least for these three Gram-negative bacteria. We must increase our efforts to preserve the activity of available antibiotics, or at least expand as much as possible the period of their use, whilst intense research efforts should be focused on the development and introduction into clinical practice of new antimicrobial agents.
铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌中不断演变的抗菌药物耐药性问题，已导致临床分离株出现，这些分离株仅对一类抗菌药物敏感，最终出现对所有可用抗生素均耐药的泛耐药（PDR）分离株。我们回顾了实验室和临床研究中的现有证据，这些研究报告了耐多粘菌素和/或PDR铜绿假单胞菌、鲍曼不动杆菌或肺炎克雷伯菌的临床分离株情况。11项实验室研究报告了对多粘菌素耐药的分离株，其中3项研究（包括2项监测研究）还纳入了有关PDR分离株的数据。此外，两项临床研究（来自中欧和南欧）报告了感染PDR分离株患者的临床特征和转归。这些数据表明，耐多粘菌素或PDR铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌的临床分离株目前相对少见。然而，由于它们所带来的治疗问题，它们具有重要的全球公共卫生意义。至少对于这三种革兰氏阴性菌而言，对抗生素后时代到来的担忧似乎是合理的。我们必须加大力度保持现有抗生素的活性，或者至少尽可能延长其使用期限，同时应集中大量研究工作致力于开发新型抗菌药物并将其引入临床实践。
