Sujatha S, Praharaj Ira
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
Interdiscip Perspect Infect Dis. 2012;2012:781679. doi: 10.1155/2012/781679. Epub 2012 Jun 19.
Vancomycin-resistant enterococci (VRE) have emerged as important nosocomial pathogens in the past two decades all over the world and have seriously limited the choices available to clinicians for treating infections caused by these agents. Methicillin-resistant Staphylococcus aureus, perhaps the most notorious among the nosocomial pathogens, was till recently susceptible to vancomycin and the other glycopeptides. Emergence of vancomycin nonsusceptible strains of S. aureus has led to a worrisome scenario where the options available for treating serious infections due to these organisms are very limited and not well evaluated. Vancomycin resistance in clinically significant isolates of coagulase-negative staphylococci is also on the rise in many setups. This paper aims to highlight the genetic basis of vancomycin resistance in Enterococcus species and S. aureus. It also focuses on important considerations in detection of vancomycin resistance in these gram-positive bacteria. The problem of glycopeptide resistance in clinical isolates of coagulase-negative staphylococci and the phenomenon of vancomycin tolerance seen in some strains of Streptococcus pneumoniae has also been discussed. Finally, therapeutic options available and being developed against these pathogens have also found a mention.
在过去二十年里，耐万古霉素肠球菌（VRE）已成为全球重要的医院感染病原菌，严重限制了临床医生治疗由这些病原体引起的感染时的用药选择。耐甲氧西林金黄色葡萄球菌可能是医院感染病原菌中最臭名昭著的，直到最近它对万古霉素和其他糖肽类药物仍敏感。耐万古霉素金黄色葡萄球菌菌株的出现导致了一种令人担忧的情况，即治疗由这些微生物引起的严重感染的可用选择非常有限且未得到充分评估。在许多医疗机构中，凝固酶阴性葡萄球菌临床重要分离株中的万古霉素耐药性也在上升。本文旨在强调肠球菌属和金黄色葡萄球菌中万古霉素耐药性的遗传基础。它还重点关注这些革兰氏阳性菌中万古霉素耐药性检测的重要注意事项。本文还讨论了凝固酶阴性葡萄球菌临床分离株中的糖肽类耐药问题以及在一些肺炎链球菌菌株中出现的万古霉素耐受性现象。最后，也提到了针对这些病原体的现有及正在研发的治疗选择。
