Patterson J E, Zervos M J
Department of Medicine and Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.
Rev Infect Dis. 1990 Jul-Aug;12(4):644-52. doi: 10.1093/clinids/12.4.644.
Antibiotic resistance is an ever-increasing problem in enterococci. These bacteria are remarkable in their ability to acquire and disseminate antibiotic resistance genes by a variety of routes. Since first described in 1979, high-level resistance to gentamicin (MIC, greater than 2,000 micrograms/mL) has spread worldwide and has been responsible for serious infections. Resistance is plasmid-mediated and due to aminoglycoside-modifying enzymes. High-level gentamicin resistance indicates that there will be no synergistic bactericidal activity with penicillin-gentamicin combinations. The epidemiology of nosocomial enterococcal infections is remarkably similar to that of nosocomial infections caused by methicillin-resistant staphylococci and by multidrug-resistant gram-negative bacilli. The most likely way these resistant bacteria are spread among hospital patients is via transient carriage on the hands of hospital personnel. Patient-to-patient and interhospital transmission of strains has been reported recently. However, clonal dissemination is not the cause of the increased frequency of resistant strains, since gentamicin resistance appears in a variety of different conjugative and nonconjugative plasmids in Enterococcus.
抗生素耐药性在肠球菌中是一个日益严重的问题。这些细菌通过多种途径获取和传播抗生素耐药基因的能力很强。自1979年首次被描述以来，对庆大霉素的高水平耐药（最低抑菌浓度[MIC]大于2000微克/毫升）已在全球范围内传播，并导致了严重感染。耐药性是由质粒介导的，且归因于氨基糖苷类修饰酶。高水平庆大霉素耐药表明青霉素-庆大霉素联合用药不会产生协同杀菌活性。医院内肠球菌感染的流行病学与耐甲氧西林葡萄球菌和多重耐药革兰氏阴性杆菌引起的医院感染非常相似。这些耐药细菌在医院患者中传播的最可能途径是通过医院工作人员手上的短暂携带。最近已有菌株在患者之间和医院间传播的报道。然而，克隆传播并非耐药菌株频率增加的原因，因为庆大霉素耐药性出现在肠球菌的多种不同接合型和非接合型质粒中。
