Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Curr Opin Infect Dis. 2012 Aug;25(4):371-7. doi: 10.1097/QCO.0b013e3283558c17.
Multidrug-resistant (MDR) Enterobacteriaceae are an emerging and a major concern for the medical community. Reported rates of MDR Enterobacteriaceae are increasing, and infections with these organisms are no longer limited to those associated with healthcare in the severely ill or infirm. Community-acquired infections are now described. The purpose of this review is to provide the readers with an up to date picture of MDR Enterobacteriaceae and to highlight the infection prevention practices that will impede the spread of this public health threat.
The epidemiology of MDR Enterobacteriaceae is rapidly evolving. Among the various MDR Gram-negatives, carbapenemase-producing organisms have been some of the most concerning. Descriptions of the global spread of carbapenemase-producing Enterobacteriaceae, and emerging epidemiology including the findings of the New Delhi metallo beta-lactamase (NDM) in water and other environmental sources, have forced reconsideration of prevention strategies. Similarly, food-borne outbreaks of extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have also caused public health experts to rethink approaches to control their spread. Finally, several articles published in the past year address the challenges and contemporary strategies to combat the MDR Enterobacteriaceae.
The speed with which the newest resistance genes have disseminated among the different Gram-negative species and around the world is such that it is now considered a global public health crisis. Proposed infection prevention and control practices related to MDR Enterobacteriaceae are primarily 'bundled' and based on clinical case reports derived from outbreak-like situations, on expert opinion and understanding about other Gram-negatives.
多药耐药（MDR）肠杆菌科是一个新兴的、令医学界高度关注的问题。MDR 肠杆菌科的报告发病率正在上升，并且这些生物体的感染不再仅限于重症或体弱患者与医疗保健相关的感染。现在已经描述了社区获得性感染。本文的目的是为读者提供 MDR 肠杆菌科的最新情况，并强调将阻碍这一公共卫生威胁传播的感染预防措施。
MDR 肠杆菌科的流行病学正在迅速演变。在各种 MDR 革兰氏阴性菌中，产碳青霉烯酶的生物体一直是最令人担忧的。产碳青霉烯酶肠杆菌科在全球的传播情况以及新兴的流行病学情况，包括新德里金属β-内酰胺酶（NDM）在水和其他环境来源中的发现，迫使人们重新考虑预防策略。同样，食源性产超广谱β-内酰胺酶（ESBL）肠杆菌科的暴发也促使公共卫生专家重新考虑控制其传播的方法。最后，过去一年发表的几篇文章探讨了应对 MDR 肠杆菌科的挑战和当代策略。
最新耐药基因在不同革兰氏阴性菌种和世界各地的传播速度如此之快，以至于现在被认为是一场全球公共卫生危机。与 MDR 肠杆菌科相关的拟议感染预防和控制措施主要是“捆绑式”的，基于来自暴发样情况的临床病例报告、专家意见以及对其他革兰氏阴性菌的了解。
