Department of Internal Medicine, Division of Infectious Diseases and Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School at Houston, Houston, TX, USA.
Clin Microbiol Infect. 2010 Jun;16(6):555-62. doi: 10.1111/j.1469-0691.2010.03214.x.
Enterococci are organisms with a remarkable ability to adapt to the environment and acquire antibiotic resistance determinants. The evolution of antimicrobial resistance in these organisms poses enormous challenges for clinicians when faced with patients affected with severe infections. The increased prevalence and dissemination of multidrug-resistant Enterococcus faecium worldwide has resulted in a major decrease in therapeutic options because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin, and exhibit high-level resistance to aminoglycosides, which are three of the traditionally most useful anti-enterococcal antibiotics. Newer antibiotics such as linezolid, daptomycin and tigecycline have good in vitro activity against enterococcal isolates, although their clinical use may be limited in certain clinical scenarios as a result of reduced rates of success, possible underdosing for enterococci and low serum levels, respectively, and also by the emergence of resistance. The experimental agent oritavancin may offer some hope for the treatment of vancomycin-resistant enterococci but clinical data are still lacking. Thus, optimal therapies for the treatment of multidrug-resistant enterococcal infections continue to be based on empirical observations and extrapolations from in vitro and animal data. Clinical studies evaluating new strategies, including combination therapies, to treat severe vancomycin-resistant E. faecium infections are urgently needed.
肠球菌是一种具有显著适应环境和获得抗生素耐药性决定因素能力的生物体。这些生物体对抗菌药物的耐药性的进化给临床医生在面对严重感染的患者时带来了巨大的挑战。由于大多数粪肠球菌分离株现在对氨苄西林和万古霉素耐药，并对氨基糖苷类药物表现出高水平耐药，而这些药物是传统上最有用的三种抗肠球菌抗生素，因此全球范围内多药耐药粪肠球菌的患病率和传播率增加，导致治疗选择大大减少。新型抗生素，如利奈唑胺、达托霉素和替加环素，对肠球菌分离株具有良好的体外活性，但其临床应用可能会受到限制，原因分别是成功率降低、对肠球菌可能剂量不足和血清水平低，此外还存在耐药性问题。实验药物奥利万星可能为治疗耐万古霉素肠球菌提供了一些希望，但仍缺乏临床数据。因此，治疗多药耐药肠球菌感染的最佳疗法仍然基于经验观察和体外及动物数据的推断。迫切需要评估新策略（包括联合治疗）的临床研究，以治疗严重的耐万古霉素粪肠球菌感染。
