Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
FEMS Microbiol Rev. 2011 Sep;35(5):901-11. doi: 10.1111/j.1574-6976.2011.00289.x. Epub 2011 Jul 29.
Unfortunately for mankind, it is very likely that the antibiotic resistance problem we have generated during the last 60 years due to the extensive use and misuse of antibiotics is here to stay for the foreseeable future. This view is based on theoretical arguments, mathematical modeling, experiments and clinical interventions, suggesting that even if we could reduce antibiotic use, resistant clones would remain persistent and only slowly (if at all) be outcompeted by their susceptible relatives. In this review, we discuss the multitude of mechanisms and processes that are involved in causing the persistence of chromosomal and plasmid-borne resistance determinants and how we might use them to our advantage to increase the likelihood of reversing the problem. Of particular interest is the recent demonstration that a very low antibiotic concentration can be enriching for resistant bacteria and the implication that antibiotic release into the environment could contribute to the selection for resistance. Several mechanisms are contributing to the stability of antibiotic resistance in bacterial populations and even if antibiotic use is reduced it is likely that most resistance mechanisms will persist for considerable times.
不幸的是，人类很可能会面临这样一种局面：由于过去 60 年来抗生素的广泛和不当使用，我们已经产生了抗生素耐药性问题，而在可预见的未来，这种问题很可能会持续存在。这种观点是基于理论论证、数学建模、实验和临床干预得出的，表明即使我们能够减少抗生素的使用，耐药克隆仍然会持续存在，并且只有在缓慢的情况下（如果有的话）才会被它们敏感的亲缘体所取代。在这篇综述中，我们讨论了导致染色体和质粒携带的耐药决定因素持续存在的多种机制和过程，以及我们如何利用这些机制和过程来增加逆转这一问题的可能性。特别值得关注的是，最近的研究表明，非常低的抗生素浓度可以富集耐药细菌，这意味着抗生素释放到环境中可能会导致耐药性的选择。有几个机制有助于细菌种群中抗生素耐药性的稳定性，即使减少抗生素的使用，大多数耐药机制也可能会持续相当长的时间。
