Casellas José María
Rev Panam Salud Publica. 2011 Dec;30(6):519-28.
Antibacterial drug resistance is a particularly significant issue in Latin America. This article explores antimicrobial resistance in three classes of clinically important bacteria: gram-positive bacteria, enterobacteria, and nonfermenting gram-negative bacilli. The gram-positive bacteria frequently responsible for infections in humans are for the most part cocci: staphylococci, streptococci (including pneumococci), and enterococci, in both community and hospital settings. This situation is no different in the Region of the Americas. Among the gram-positive bacteria, the causative agents of bacteremia are most commonly strains of coagulase-negative Staphylococcus, followed by enterococci. This report explores the resistance of these species to different antimicrobial drugs, resistance mechanisms in community and hospital strains, and new drugs for treating infections caused by these bacteria. In Latin America, antimicrobial resistance in Enterococcus strains is still a minor problem compared to the situation in the United States. The strains of the genus Streptococcus isolated from respiratory infections are still sensitive to penicillin. Furthermore, the resistance of enterobacteria is extremely important in the Region, particularly because of the broad dissemination of CTX-M extended-spectrum beta-lactamases (ESBL), some of which originated in Latin America. This article analyzes the resistance of Streptococcus pneumoniae, beta-hemolytic streptococci, and viridans group streptococci. Among the nonfermenting gram-negative bacilli, while Pseudomonas aeruginosa strains remain the leading cause of bacteremia, infections caused by strains of Acinetobacter spp. have proliferated extensively in some areas. With regard to antibiotics, several options are available for treating gram-positive bacterial infections. The same cannot be said for infections caused by enterobacteria and nonfermenting gram-negative bacilli, where options for the effective treatment of patients are still insufficient.
抗菌药物耐药性在拉丁美洲是一个尤为重要的问题。本文探讨了三类临床上重要细菌的耐药性：革兰氏阳性菌、肠杆菌科细菌和非发酵革兰氏阴性杆菌。在社区和医院环境中，人类感染中常见的革兰氏阳性菌大多为球菌：葡萄球菌、链球菌（包括肺炎链球菌）和肠球菌。在美洲地区也是如此。在革兰氏阳性菌中，菌血症的病原体最常见的是凝固酶阴性葡萄球菌菌株，其次是肠球菌。本报告探讨了这些菌种对不同抗菌药物的耐药性、社区和医院菌株中的耐药机制以及治疗这些细菌引起的感染的新药。在拉丁美洲，与美国的情况相比，肠球菌菌株的抗菌药物耐药性仍是一个较小的问题。从呼吸道感染中分离出的链球菌属菌株对青霉素仍然敏感。此外，肠杆菌科细菌的耐药性在该地区极为重要，特别是由于CTX-M超广谱β-内酰胺酶（ESBL）的广泛传播，其中一些起源于拉丁美洲。本文分析了肺炎链球菌、β溶血性链球菌和草绿色链球菌的耐药性。在非发酵革兰氏阴性杆菌中，虽然铜绿假单胞菌菌株仍然是菌血症的主要原因，但不动杆菌属菌株引起的感染在一些地区已广泛增多。关于抗生素，有几种选择可用于治疗革兰氏阳性菌感染。对于肠杆菌科细菌和非发酵革兰氏阴性杆菌引起的感染则并非如此，在这些感染中，有效治疗患者的选择仍然不足。
