Morosini María Isabel, Cercenado Emilia, Ardanuy Carmen, Torres Carmen
Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, España.
Enferm Infecc Microbiol Clin. 2012 Jun;30(6):325-32. doi: 10.1016/j.eimc.2011.09.009. Epub 2011 Nov 29.
Antimicrobial resistance mechanisms among clinically relevant gram-positive microorganisms can be demonstrated using phenotypic tests that enable the interpretation of underlying mechanisms responsible for the in vitro resistance. The reporting of these mechanisms, either inferred or demonstrated, helps in the adjustment of clinical treatments and the epidemiological follow up of resistance traits. In the present work, phenotypic tests for detection of antimicrobial resistance mechanisms involving the most frequent antimicrobial families used against Staphylococcus spp., Enterococcus spp. and Streptococcus pneumoniae are analysed. In the case of Staphylococcus, phenotypic tests to reveal the mechanisms of resistance against beta-lactams, macrolides, lincosamides and streptogramin B (MLS(B)), as well as intermediate susceptibility to glycopeptides, resistance to aminoglycosides, mupirocin and linezolid are reviewed. Tests to detect glycopeptide resistance and high-level aminoglycoside resistance among enterococci are analysed. Detection of penicillin resistance, as well as diminished susceptibility to third generation cephalosporins, together with diminished susceptibility or even resistance to fluoroquinolones is also detailed.
使用能够解释体外耐药潜在机制的表型试验，可以证明临床相关革兰氏阳性微生物中的抗菌耐药机制。这些机制的报告，无论是推断的还是已证实的，都有助于调整临床治疗以及对抗药性状进行流行病学随访。在本研究中，分析了用于检测涉及针对葡萄球菌属、肠球菌属和肺炎链球菌使用的最常见抗菌药物家族的抗菌耐药机制的表型试验。对于葡萄球菌，回顾了揭示对β-内酰胺类、大环内酯类、林可酰胺类和链阳菌素B（MLS(B)）耐药机制以及对糖肽类药物中度敏感、对氨基糖苷类、莫匹罗星和利奈唑胺耐药的表型试验。分析了检测肠球菌中糖肽类耐药和高水平氨基糖苷类耐药的试验。还详细介绍了青霉素耐药以及对第三代头孢菌素敏感性降低，以及对氟喹诺酮类药物敏感性降低甚至耐药的检测情况。
