Chastre J
Université Paris 6 Pierre et Marie Curie, Service de Reanimation Medicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
Clin Microbiol Infect. 2008 Apr;14 Suppl 3:3-14. doi: 10.1111/j.1469-0691.2008.01958.x.
Over the past decade, patterns of resistance to antimicrobial agents have changed dramatically, particularly because of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA), as well as the increasing rate of antimicrobial resistance seen in several species of Gram-negative bacteria. The unique nature of the intensive care unit (ICU) environment makes it a focus for the emergence and spread of many antimicrobial-resistant pathogens. The patients in this setting are commonly exposed to broad-spectrum antimicrobial agents, and opportunities for the cross-transmission of resistant bacteria from patient to patient abound. Not surprisingly, resistance rates have increased for most pathogens associated with nosocomial infections among ICU patients, and rates are almost universally higher among ICU patients than among non-ICU patients. MRSA strains are now spreading in the community, possibly because of antibiotic pressure outside the hospital, but also because of transfer from hospital settings. Such strains are worrisome, particularly the strains carrying the gene for Panton-Valentine leukocidin (PVL), which has been associated with heightened virulence. Managing infections caused by today's pathogens requires avoidance of antimicrobial agent overuse and appropriate selection, dosing and duration of efficacious antimicrobial therapy.
在过去十年中，对抗菌药物的耐药模式发生了巨大变化，尤其是由于耐甲氧西林金黄色葡萄球菌（MRSA）的患病率不断上升，以及几种革兰氏阴性菌的抗菌耐药率不断提高。重症监护病房（ICU）环境的独特性质使其成为许多抗菌耐药病原体出现和传播的焦点。在这种环境中的患者通常会接触到广谱抗菌药物，耐药细菌在患者之间交叉传播的机会很多。不出所料，ICU患者中与医院感染相关的大多数病原体的耐药率都有所上升，而且ICU患者中的耐药率几乎普遍高于非ICU患者。MRSA菌株现在正在社区中传播，这可能是由于医院外的抗生素压力，但也可能是由于从医院环境中传播所致。此类菌株令人担忧，尤其是携带杀白细胞素（PVL）基因的菌株，该基因与毒力增强有关。应对当今病原体引起的感染需要避免过度使用抗菌药物，并合理选择、确定有效抗菌治疗的剂量和疗程。
