Department of Medicine, Mount Sinai School of Medicine New York, NY, USA.
Front Microbiol. 2013 Mar 14;4:48. doi: 10.3389/fmicb.2013.00048. eCollection 2013.
Carbapenems, once considered the last line of defense against of serious infections with Enterobacteriaceae, are threatened with extinction. The increasing isolation of carbapenem-resistant Gram-negative pathogens is forcing practitioners to rely on uncertain alternatives. As little as 5 years ago, reports of carbapenem resistance in Enterobacteriaceae, common causes of both community and healthcare-associated infections, were sporadic and primarily limited to case reports, tertiary care centers, intensive care units, and outbreak settings. Carbapenem resistance mediated by β-lactamases, or carbapenemases, has become widespread and with the paucity of reliable antimicrobials available or in development, international focus has shifted to early detection and infection control. However, as reports of Klebsiella pneumoniae carbapenemases, New Delhi metallo-β-lactamase-1, and more recently OXA-48 (oxacillinase-48) become more common and with the conveniences of travel, the assumption that infections with highly resistant Gram-negative pathogens are limited to the infirmed and the heavily antibiotic and healthcare exposed are quickly being dispelled. Herein, we provide a status report describing the increasing challenges clinicians are facing and forecast the "stormy waters" ahead.
碳青霉烯类抗生素曾被认为是治疗肠杆菌科严重感染的最后一道防线，但如今却面临着灭绝的威胁。越来越多的耐碳青霉烯类革兰氏阴性病原体的出现，迫使临床医生不得不依赖不确定的替代药物。就在短短 5 年前，肠杆菌科（引起社区感染和医院获得性感染的常见病原体）中碳青霉烯类耐药的报告还很罕见，主要限于病例报告、三级保健中心、重症监护病房和暴发环境。由β-内酰胺酶（碳青霉烯酶）介导的碳青霉烯类抗生素耐药性已经广泛存在，由于缺乏可靠的抗菌药物，国际社会的注意力已经转向早期检测和感染控制。然而，随着肺炎克雷伯菌碳青霉烯酶、新德里金属β-内酰胺酶 1 以及最近的 OXA-48（oxacillinase-48）的报道越来越多，再加上旅行的便利，人们认为携带高度耐药性革兰氏阴性病原体的感染仅限于身体虚弱和大量使用抗生素及接受医疗护理的人群的这种假设，正在迅速被打破。在此，我们提供了一份现状报告，描述了临床医生目前面临的日益严峻的挑战，并预测了未来的“惊涛骇浪”。
