Hamilton-Miller J M
Department of Medical Microbiology, Royal Free Hospital and School of Medicine, London, UK.
Intensive Care Med. 1990;16 Suppl 3:S206-11. doi: 10.1007/BF01709702.
Selection pressure, caused by the use of antibiotics--especially in hospitals--is the main factor responsible for the emergence of antibiotic-resistant bacteria. Resistance can arise endogenously by mutation (one-step, as found for Mycobacterium tuberculosis to rifampicin, or multi-step, as in gonococci to benzylpenicillin), or exogenously by transfer of R-factors. Mechanisms of resistance may involve a decrease in permeability, chemical modification of the antibiotic, or a change in the affinity of the target site. There are many misconceptions concerning the incidence, nature and spread of antibiotic resistance, and some of the most important of these are discussed. The emergence and spread of resistance can be controlled by adhering to antibiotic policies and by preventing or controlling outbreaks of infection. The importance of resistant organisms can be diminished by the development of new antibiotic agents, preferably containing new chemical entities.
抗生素的使用所产生的选择压力——尤其是在医院中——是导致抗生素耐药菌出现的主要因素。耐药性可通过突变内源性产生（如结核分枝杆菌对利福平的一步突变，或淋球菌对苄青霉素的多步突变），或通过R因子的转移外源性产生。耐药机制可能涉及通透性降低、抗生素的化学修饰或靶位点亲和力的改变。关于抗生素耐药性的发生率、性质和传播存在许多误解，本文将讨论其中一些最重要的误解。通过坚持抗生素使用策略以及预防或控制感染暴发，可以控制耐药性的出现和传播。通过开发新的抗生素药物，最好是含有新化学实体的药物，可以降低耐药菌的重要性。
