Cornaglia G
Clin Microbiol Infect. 2009 Mar;15(3):209-11. doi: 10.1111/j.1469-0691.2009.02737.x.
Growing bacterial resistance in Gram-positive pathogens means that what were once effective and inexpensive treatments for infections caused by these bacteria are now being seriously questioned, including penicillin and macrolides for use against pneumococcal infections and-in hospitals-oxacillin for use against staphylococcal infections. As a whole, multidrug-resistant (MDR) Gram-positive pathogens are rapidly becoming an urgent and sometimes unmanageable clinical problem. Nevertheless, and despite decades of research into the effects of antibiotics, the actual risk posed to human health by antibiotic resistance has been poorly defined; the lack of reliable data concerning the outcomes resulting from antimicrobial resistance stems, in part, from problems with study designs and the methods used in resistence determination. Surprisingly little is known, too, about the actual effectiveness of the many types of intervention aimed at controlling antibiotic resistance. New antibiotics active against MDR Gram-positive pathogens have been recently introduced into clinical practice, and the antibiotic pipeline contains additional compounds at an advanced stage of development, including new glycopeptides, new anti-methicillin-resistant Staphylococcus aureus (MRSA) beta-lactams, and new diaminopyrimidines. Many novel antimicrobial agents are likely to be niche products, endowed with narrow antibacterial spectra and/or targeted at specific clinical problems. Therefore, an important educational goal will be to change the current, long-lasting attitudes of both physicians and customers towards broad-spectrum and multipurpose compounds. Scientific societies, such as the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), must play a leading role in this process.
革兰氏阳性病原体中不断增强的细菌耐药性意味着，曾经对这些细菌引起的感染有效且廉价的治疗方法，如今正受到严重质疑，其中包括用于治疗肺炎球菌感染的青霉素和大环内酯类药物，以及在医院中用于治疗葡萄球菌感染的苯唑西林。总体而言，耐多药（MDR）革兰氏阳性病原体正迅速成为一个紧迫且有时难以控制的临床问题。然而，尽管对抗生素的影响进行了数十年的研究，但抗生素耐药性对人类健康构成的实际风险仍未得到明确界定；关于抗菌药物耐药性导致的后果缺乏可靠数据，部分原因在于研究设计和耐药性测定所采用方法存在问题。同样令人惊讶的是，对于旨在控制抗生素耐药性的多种干预措施的实际效果，人们了解得也很少。针对耐多药革兰氏阳性病原体的新型抗生素最近已引入临床实践，而且在研的抗生素中还有处于研发后期的其他化合物，包括新型糖肽类、新型抗耐甲氧西林金黄色葡萄球菌（MRSA）β-内酰胺类，以及新型二氨基嘧啶类。许多新型抗菌药物可能是针对特定需求的产品，具有窄抗菌谱和/或针对特定临床问题。因此，一个重要的教育目标将是改变医生和患者长期以来对广谱和多用途化合物的态度。科学协会，如欧洲临床微生物学和传染病学会（ESCMID），必须在这一过程中发挥主导作用。
