Hawkey P M
Division of Immunity and Infection, University of Birmingham, Birmingham and Health Protection Agency, West Midlands Public Health Laboratory, Birmingham Heart of England NHS Trust, Bordesley Green East, Birmingham, UK.
Clin Microbiol Infect. 2008 Jan;14 Suppl 1:159-65. doi: 10.1111/j.1469-0691.2007.01855.x.
Asia is almost certainly a part of the world in which extended-spectrum beta-lactamases (ESBLs) have emerged de novo, with some early antimicrobial resistance studies showing high levels of the ESBL phenotype, particularly among Klebsiella, and most notably in China, Korea, Japan and India. There is a lack of genotyping studies but work from the late 1990s suggests that SHV-5 and SHV-12 were most common then, with only very rare reports of TEM-related ESBL genes. As in other parts of the world, quite marked differences have since been seen in the pattern of ESBL genes, particularly in relation to the CTX-M family. The early emergence of TOHO CTX-M-2 in Japan contrasted with CTX-M-3 and -14 in China and many other parts of the Far East, suggesting the separate transfer of genes from the genome of Kluyvera spp. to mobile genetic elements in human-associated Enterobacteriaceae. ESBL production rates are now very high compared with Europe. In most countries, there are mixtures of CTX-M types, with VEB appearing significantly in Vietnam and Thailand, and ESBL isolates from India being completely dominated by the presence of bla(CTX-M-15) alone, with no other CTX-M types reported. With the total population of India and China being c. 2.4 billion and with faecal carriage rates of, probably, c. 10%, these countries represent major reservoirs of bla(CTX-M) genes. Increasing international travel and trade will lead to the movement of many of these ESBL genes. The high prevalence of ESBL genes in Asia means that the empirical treatment of serious infections with beta-lactam antibiotics, except carbapenems, is seriously compromised.
亚洲几乎肯定是超广谱β-内酰胺酶（ESBLs）在世界范围内首次出现的地区之一，一些早期的抗菌药物耐药性研究显示ESBL表型水平很高，尤其是在克雷伯菌属中，最显著的是在中国、韩国、日本和印度。目前缺乏基因分型研究，但20世纪90年代末的研究表明，当时SHV-5和SHV-12最为常见，与TEM相关的ESBL基因报告非常罕见。与世界其他地区一样，此后ESBL基因模式出现了相当明显的差异，特别是与CTX-M家族有关。日本TOHO CTX-M-2的早期出现与中国及远东其他许多地区的CTX-M-3和-14形成对比，这表明基因从克吕沃菌属基因组向人类相关肠杆菌科的移动遗传元件的单独转移。与欧洲相比，目前亚洲的ESBL产生率非常高。在大多数国家，存在多种CTX-M类型的混合，VEB在越南和泰国显著出现，印度的ESBL分离株完全由bla(CTX-M-15)单独存在所主导，未报告其他CTX-M类型。印度和中国的总人口约为24亿，粪便携带率可能约为10%，这些国家是bla(CTX-M)基因的主要储存库。日益增加的国际旅行和贸易将导致许多此类ESBL基因的传播。亚洲ESBL基因的高流行意味着除碳青霉烯类外，使用β-内酰胺类抗生素对严重感染进行经验性治疗受到严重影响。
