Tristram Stephen, Jacobs Michael R, Appelbaum Peter C
School of Human Life Sciences, University of Tasmania, Locked Bag 1320, Launceston 7250, Australia.
Clin Microbiol Rev. 2007 Apr;20(2):368-89. doi: 10.1128/CMR.00040-06.
Haemophilus influenzae is a major community-acquired pathogen causing significant morbidity and mortality worldwide. Meningitis and bacteremia due to type b strains occur in areas where the protein-conjugated type b vaccine is not in use, whereas nontypeable strains are major causes of otitis media, sinusitis, acute exacerbations of chronic bronchitis, and pneumonia. Antibiotic resistance in this organism is more diverse and widespread than is commonly appreciated. Intrinsic efflux resistance mechanisms limit the activity of the macrolides, azalides, and ketolides. beta-Lactamase production is highly prevalent worldwide and is associated with resistance to ampicillin and amoxicillin. Strains with alterations in penicillin binding proteins, particularly PBP3 (beta-lactamase negative ampicillin resistant and beta-lactamase positive amoxicillin-clavulanate resistant), are increasing in prevalence, particularly in Japan, with increasing resistance to ampicillin, amoxicillin, amoxicillin-clavulanate, and many cephalosporins, limiting the efficacy of expanded-spectrum cephalosporins against meningitis and of many oral cephalosporins against other diseases. Most strains remain susceptible to the carbapenems, which are not affected by penicillin binding protein changes, and the quinolones. The activity of many oral agents is limited by pharmacokinetics achieved with administration by this route, and the susceptibility of isolates based on pharmacokinetic and pharmacodynamic parameters is reviewed.
流感嗜血杆菌是一种主要的社区获得性病原体，在全球范围内导致显著的发病率和死亡率。b型菌株引起的脑膜炎和菌血症发生在未使用蛋白结合b型疫苗的地区，而不可分型菌株是中耳炎、鼻窦炎、慢性支气管炎急性加重和肺炎的主要病因。该生物体中的抗生素耐药性比通常认为的更加多样和广泛。内在的外排耐药机制限制了大环内酯类、氮杂内酯类和酮内酯类的活性。β-内酰胺酶的产生在全球范围内非常普遍，并且与对氨苄西林和阿莫西林的耐药性有关。青霉素结合蛋白发生改变的菌株，特别是PBP3（β-内酰胺酶阴性氨苄西林耐药和β-内酰胺酶阳性阿莫西林-克拉维酸耐药），其流行率正在增加，尤其是在日本，对氨苄西林、阿莫西林、阿莫西林-克拉维酸和许多头孢菌素的耐药性不断增加，限制了广谱头孢菌素对脑膜炎的疗效以及许多口服头孢菌素对其他疾病的疗效。大多数菌株对碳青霉烯类和喹诺酮类仍然敏感，碳青霉烯类不受青霉素结合蛋白变化的影响。许多口服药物的活性受到通过该途径给药所达到的药代动力学的限制，并且基于药代动力学和药效学参数对分离株的敏感性进行了综述。
