Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Curr Opin Crit Care. 2011 Dec;17(6):658-65. doi: 10.1097/MCC.0b013e32834c9d87.
Antimicrobial resistance is an emerging problem in ICUs worldwide. As numbers of published results from national/international surveillance studies rise rapidly, the amount of new information may be overwhelming. Therefore, we reviewed recent trends in antibiotic resistance in ICUs across Europe in the past 18 months.
In this period, infections caused by methicillin-resistant Staphylococcus aureus appeared to stabilize (and even decrease) in some countries, and infection rates due to Gram-positive bacteria resistant to vancomycin, linezolid or daptomycin have remained low. In contrast, we are witnessing a continent-wide emergence of infections caused by multiresistant Gram-negative bacteria, especially Escherichia coli and Klebsiella pneumoniae, with easily exchangeable resistance genes located on plasmids, producing enzymes such as extended spectrum β-lactamases and carbapenamases. In the absence of new antibiotics, prevention of infections, reducing unnecessary antibiotic use, optimizing adherence to universal hygienic and infection control measures, and improving implementation of diagnostic tests are our only tools to combat this threat.
As the epidemiology of antibiotic resistance in ICUs is rapidly changing toward more frequently occurring epidemics and endemicity of multi and panresistant Gram-negative pathogens, better infection control and improved diagnostics will become even more important than before.
抗微生物药物耐药性是全球 ICU 中一个新出现的问题。随着来自国家/国际监测研究的发表结果数量迅速增加，新信息可能会让人应接不暇。因此，我们回顾了过去 18 个月欧洲 ICU 中抗生素耐药性的最新趋势。
在此期间，耐甲氧西林金黄色葡萄球菌引起的感染在一些国家似乎趋于稳定（甚至减少），而对万古霉素、利奈唑胺或达托霉素耐药的革兰阳性菌引起的感染率仍然较低。相比之下，我们正在目睹整个欧洲大陆由多重耐药革兰氏阴性菌引起的感染的出现，尤其是大肠杆菌和肺炎克雷伯菌，这些细菌的耐药基因很容易在质粒上交换，产生如扩展谱β-内酰胺酶和碳青霉烯酶等酶。在没有新抗生素的情况下，预防感染、减少不必要的抗生素使用、优化对普遍卫生和感染控制措施的遵守情况，以及改进诊断检测的实施，是我们对抗这一威胁的唯一工具。
由于 ICU 中抗生素耐药性的流行病学正迅速朝着更频繁发生的流行和多药及泛耐药革兰氏阴性病原体的地方病方向发展，更好的感染控制和改进的诊断将变得比以往任何时候都更加重要。
