Juan Nicolau Carlos, Oliver Antonio
Hospital Son Dureta, Universitat de les Illes Balears, Institut Universitari d' Investigació en Ciències de la Salut, Palma de Mallorca, España.
Enferm Infecc Microbiol Clin. 2010 Jan;28 Suppl 1:19-28. doi: 10.1016/S0213-005X(10)70004-5.
Pseudomonas aeruginosa is one of the most relevant nosocomial pathogens, as well as one of the main causes of chronic respiratory infections in patients with underlying diseases such as cystic fibrosis or chronic obstructive pulmonary disease. The high intrinsic antibiotic resistance of this pathogen, together with its extraordinary capacity for acquiring additional resistances through chromosomal mutations, determines a major threat for antimicrobial therapy in hospitals worldwide. Even more concerning is the increasing detection of multiple antimicrobial resistance determinants in this microorganism, frequently located on integrons, acquired by horizontal transfer through plasmids and/or transposons. Among these mechanisms, the carbapenemases are particularly relevant, due to the wide spectrum of antibiotics affected. This work reviews the epidemiology, impact, and detection of the carbapenemases described so far in the Pseudomonas spp., that mainly include class B enzymes (metallo-beta-lactamases [MBL]: IMP, VIM, SPM, GIM, AIM, or DIM), but also, to a lower extent, class A (GES y KPC) and D (OXA) beta-lactamases. The presence of transferable carbapenemases is not only important in P. aeruginosa, but also in other less clinically-relevant species of the genus, since they can act as reservoires and dispersion vectors of these resistance determinants. The growing prevalence of carbapenemase-producing clinical isolates calls for the implementation of multidisciplinary strategies to optimize the detection and minimize the dissemination of these multidrug resistant strains and the involved transferable genetic elements.
铜绿假单胞菌是最重要的医院病原体之一,也是患有诸如囊性纤维化或慢性阻塞性肺疾病等基础疾病患者慢性呼吸道感染的主要病因之一。该病原体固有的高抗生素耐药性,以及其通过染色体突变获得额外耐药性的非凡能力,对全球医院的抗菌治疗构成了重大威胁。更令人担忧的是,在这种微生物中越来越多地检测到多种抗菌耐药决定因素,这些因素通常位于整合子上,通过质粒和/或转座子水平转移获得。在这些机制中,碳青霉烯酶尤为重要,因为受影响的抗生素范围广泛。这项工作回顾了迄今为止在假单胞菌属中描述的碳青霉烯酶的流行病学、影响及检测情况,这些酶主要包括B类酶(金属β-内酰胺酶[MBL]:IMP、VIM、SPM、GIM、AIM或DIM),但在较低程度上也包括A类(GES和KPC)和D类(OXA)β-内酰胺酶。可转移碳青霉烯酶的存在不仅在铜绿假单胞菌中很重要,在该属其他临床相关性较低的物种中也很重要,因为它们可作为这些耐药决定因素的储存库和传播载体。产碳青霉烯酶临床分离株的日益流行,要求实施多学科策略,以优化检测并尽量减少这些多重耐药菌株及相关可转移遗传元件的传播。
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