Maillard J-Y
Welsh School of Pharmacy, Cardiff University, Cardiff, UK.
J Hosp Infect. 2007 Jun;65 Suppl 2:60-72. doi: 10.1016/S0195-6701(07)60018-8.
The emergence of bacterial resistance following exposure in healthcare facilities has been a recurrent topic of interest over the last 10 years. The overwhelming and increasing body of evidence from studies in vitro showed that bacteria have an immense capacity to respond to chemical stress brought upon by biocides. Empirically two major types of mechanisms have been described: intrinsic and acquired. However, the increasing documented response from bacteria exposed to biocide in conditions close to those found in practice suggests that intrinsic resistance does not adequately describe bacterial survival mechanisms, and that other terms such as biofilm resistance and environmental resistance would be therefore more appropriate. In addition, such terms are more relevant when describing in-situ conditions. The lack of evidence of bacterial resistance in practice and the inability to correlate emerging bacterial resistance from in-vitro experiments with practical situations is a major drawback when attempting to ascertain whether emerging bacterial resistance in healthcare facilities is of genuine concern. Microbial resistance to high or in-use concentration of biocides has been described in practice, although it remains uncommon. The efficacy of biocides in eliminating bacterial contaminants within healthcare facilities has to be questioned with the widespread and increasing use of products containing low concentrations of biocide or possessing low bactericidal activity, as is the selection of less susceptible bacteria following such exposure.
在过去十年中，医疗机构内接触后细菌耐药性的出现一直是一个反复受到关注的话题。来自体外研究的大量且不断增加的证据表明，细菌对杀菌剂带来的化学应激具有巨大的应对能力。根据经验，已描述了两种主要类型的机制：固有耐药性和获得性耐药性。然而，越来越多的文献表明，在接近实际情况的条件下接触杀菌剂的细菌的反应表明，固有耐药性并不能充分描述细菌的生存机制，因此诸如生物膜耐药性和环境耐药性等其他术语可能更合适。此外，在描述原位条件时，这些术语更具相关性。在实际中缺乏细菌耐药性的证据，并且无法将体外实验中出现的细菌耐药性与实际情况相关联，这是在试图确定医疗机构中出现的细菌耐药性是否真正值得关注时的一个主要缺陷。尽管在实际中仍然不常见，但已经描述了微生物对高浓度或使用浓度的杀菌剂的耐药性。随着含有低浓度杀菌剂或杀菌活性低的产品的广泛使用以及此类接触后对较不易感细菌的选择，杀菌剂在消除医疗机构内细菌污染物方面的功效必须受到质疑。
