College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-no, Sangnok-gu, Ansan, Gyeonggi-do 462-791, South Korea.
Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
Int J Antimicrob Agents. 2014 Jul;44(1):8-15. doi: 10.1016/j.ijantimicag.2014.02.016. Epub 2014 Apr 12.
Increasing use of colistin for multidrug-resistant Gram-negative bacterial infections has led to the emergence of colistin resistance in Klebsiella pneumoniae in several countries worldwide, including Europe (especially Greece), and colistin resistance rates are continually increasing. Heteroresistance rates, which were significantly higher than resistance rates, were found to be important. Although the mechanism underlying resistance is unclear, it has been suggested that it is related to lipopolysaccharide modification via diverse routes. Several factors have been reported as being associated with colistin resistance, with improper use and patient-to-patient transmission being most often cited. Total infections and infection-related mortality from colistin-resistant K. pneumoniae are high, but currently there are no established treatment regimens. However, several combination regimens that are mainly colistin-based have been found to be successful for treating such infections.
由于多药耐药革兰氏阴性细菌感染中越来越多地使用粘菌素，包括欧洲（尤其是希腊）在内的世界上几个国家的肺炎克雷伯菌都出现了粘菌素耐药性，而且粘菌素耐药率还在不断上升。异质性耐药率明显高于耐药率，被认为是很重要的。尽管耐药机制尚不清楚，但有人认为它与通过不同途径的脂多糖修饰有关。据报道，有几个因素与粘菌素耐药性有关，其中最常提到的是不当使用和患者间传播。粘菌素耐药性肺炎克雷伯菌引起的总感染和感染相关死亡率很高，但目前尚无既定的治疗方案。然而，已经发现几种主要基于粘菌素的联合方案可成功治疗此类感染。
