Pitout Johann D D
Department of Pathology and Laboratory Medicine, Microbiology and Infectious Diseases, University of Calgary, Division of Microbiology, Calgary Laboratory Services, Calgary, Alberta, Canada.
Expert Rev Anti Infect Ther. 2008 Oct;6(5):657-69. doi: 10.1586/14787210.6.5.657.
The Enterobacteriaceae are among the most important causes of serious nosocomial and community-onset bacterial infections in humans, and resistance to antimicrobial agents in these species has become an increasingly relevant problem for healthcare providers. beta-lactam and fluoroquinolone antibiotics are important drug classes used to treat infections caused by Enterobacteriaceae. Emerging resistance mechanisms against these agents have recently been described in Enterobacteriaceae and include the production of newer beta-lactamases and plasmid-mediated quinolone resistance. The newer beta-lactamases consist of the following: plasmid-mediated AmpC beta-lactamases (e.g., ephamycin [CMY], CMY types), extended-spectrum beta-lactamases (e.g., cefotaxime [CTX], CTX-M first isolated at Munich) and carbapenem-hydrolyzing enzymes (e.g., Klebsiella pneumoniae carbapenemase [KPC], KPC types and the metallo-beta-lactamases). Recent developments in the epidemiology, clinical relevance and laboratory detection of infections caused by multiresistant Enterobacteriaceae with these new types of resistance mechanisms will be addressed in this review.
肠杆菌科细菌是人类严重医院感染和社区感染的最重要病因之一，这些菌种对抗菌药物的耐药性已成为医护人员日益关注的问题。β-内酰胺类和氟喹诺酮类抗生素是用于治疗肠杆菌科细菌所致感染的重要药物类别。最近在肠杆菌科细菌中发现了针对这些药物的新耐药机制，包括产生新型β-内酰胺酶和质粒介导的喹诺酮耐药性。新型β-内酰胺酶包括以下几种：质粒介导的AmpCβ-内酰胺酶（如头孢西丁酶[CMY]、CMY型）、超广谱β-内酰胺酶（如头孢噻肟酶[CTX]、最早在慕尼黑分离出的CTX-M型）和碳青霉烯水解酶（如肺炎克雷伯菌碳青霉烯酶[KPC]、KPC型和金属β-内酰胺酶）。本综述将阐述具有这些新型耐药机制的多重耐药肠杆菌科细菌所致感染在流行病学、临床意义和实验室检测方面的最新进展。
