Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Thammasat University Hospital, Pathumthani 12120, Thailand.
Adv Drug Deliv Rev. 2014 Nov 30;78:3-13. doi: 10.1016/j.addr.2014.08.003. Epub 2014 Aug 16.
Alexander Fleming's discovery of penicillin heralded an age of antibiotic development and healthcare advances that are premised on the ability to prevent and treat bacterial infections both safely and effectively. The resultant evolution of antimicrobial resistant mechanisms and spread of bacteria bearing these genetic determinants of resistance are acknowledged to be one of the major public health challenges globally, and threatens to unravel the gains of the past decades. We describe the major mechanisms of resistance to β-lactam antibiotics - the most widely used and effective antibiotics currently - in both Gram-positive and Gram-negative bacteria, and also briefly detail the existing and emergent pharmacological strategies to overcome such resistance. The global epidemiology of the four major types of bacteria that are responsible for the bulk of antimicrobial-resistant infections in the healthcare setting - methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobactericeae, and Acinetobacter baumannii - are also briefly described.
亚历山大·弗莱明发现青霉素,开创了抗生素发展和医疗保健进步的时代,其前提是能够安全有效地预防和治疗细菌感染。人们已经认识到,抗菌药物耐药机制的演变以及携带这些耐药遗传决定因素的细菌的传播,是全球主要的公共卫生挑战之一,有可能破坏过去几十年取得的成果。我们描述了革兰氏阳性菌和革兰氏阴性菌中β-内酰胺类抗生素(目前使用最广泛、最有效的抗生素)耐药的主要机制,并简要介绍了克服这种耐药性的现有和新兴药理学策略。还简要描述了在医疗环境中导致大部分抗菌药物耐药感染的四种主要细菌(耐甲氧西林金黄色葡萄球菌、万古霉素耐药肠球菌、肠杆菌科和鲍曼不动杆菌)的全球流行病学情况。