Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2011 Nov;52(6):879-91. doi: 10.3349/ymj.2011.52.6.879.
Pathogenic bacteria have increasingly been resisting to antimicrobial therapy. Recently, resistance problem has been relatively much worsened in Gram-negative bacilli. Acinetobacter spp. are typical nosocomial pathogens causing infections and high mortality, almost exclusively in compromised hospital patients. Acinetobacter spp. are intrinsically less susceptible to antibiotics than Enterobacteriaceae, and have propensity to acquire resistance. A surveillance study in Korea in 2009 showed that resistance rates of Acinetobacter spp. were very high: to fluoroquinolone 67%, to amikacin 48%, to ceftazidime 66% and to imipenem 51%. Carbapenem resistance was mostly due to OXA type carbapenemase production in A. baumannii isolates, whereas it was due to metallo-β-lactamase production in non-baumannii Acinetobacter isolates. Colistin-resistant isolates were rare but started to be isolated in Korea. Currently, the infection caused by multidrug-resistant A. baumannii is among the most difficult ones to treat. Analysis at tertiary care hospital in 2010 showed that among the 1,085 isolates of Acinetobacter spp., 14.9% and 41.8% were resistant to seven, and to all eight antimicrobial agents tested, respectively. It is known to be difficult to prevent Acinetobacter spp. infection in hospitalized patients, because the organisms are ubiquitous in hospital environment. Efforts to control resistant bacteria in Korea by hospitals, relevant scientific societies and government agencies have only partially been successful. We need concerted multidisciplinary efforts to preserve the efficacy of currently available antimicrobial agents, by following the principles of antimicrobial stewardship.
病原菌对抗菌治疗的耐药性日益增加。最近，革兰氏阴性杆菌的耐药问题相对恶化。不动杆菌属是一种典型的医院病原体，可引起感染并导致高死亡率，几乎只发生在有合并症的住院患者中。与肠杆菌科相比，不动杆菌属对抗生素的固有敏感性较低，且容易获得耐药性。2009 年韩国的一项监测研究显示，不动杆菌属的耐药率非常高：对氟喹诺酮 67%，阿米卡星 48%，头孢他啶 66%和亚胺培南 51%。碳青霉烯类耐药主要是由于鲍曼不动杆菌分离株中 OXA 型碳青霉烯酶的产生，而非鲍曼不动杆菌不动杆菌分离株中则是由于金属β-内酰胺酶的产生。粘菌素耐药分离株很少见，但已开始在韩国分离。目前，由多重耐药鲍曼不动杆菌引起的感染是最难治疗的感染之一。2010 年在三级保健医院进行的分析显示，在 1085 株不动杆菌属分离株中，分别有 14.9%和 41.8%对 7 种和所有 8 种测试的抗菌药物耐药。由于该病原体在医院环境中无处不在，因此难以预防住院患者发生不动杆菌属感染。韩国的医院、相关科学学会和政府机构为控制耐药菌所做的努力仅取得部分成功。我们需要通过遵循抗菌药物管理的原则，协调多学科努力，以保持现有抗菌药物的疗效。
