Jean Shio-Shin, Lee Wen-Sen, Lam Carlos, Hsu Chin-Wang, Chen Ray-Jade, Hsueh Po-Ren
Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Future Microbiol. 2015;10(3):407-25. doi: 10.2217/fmb.14.135.
Carbapenemases, with versatile hydrolytic capacity against β-lactams, are now an important cause of resistance of Gram-negative bacteria. The genes encoding for the acquired carbapenemases are associated with a high potential for dissemination. In addition, infections due to Gram-negative bacteria with acquired carbapenemase production would lead to high clinical mortality rates. Of the acquired carbapenemases, Klebsiella pneumoniae carbapenemase (Ambler class A), Verona integron-encoded metallo-β-lactamase (Ambler class B), New Delhi metallo-β-lactamase (Ambler class B) and many OXA enzymes (OXA-23-like, OXA-24-like, OXA-48-like, OXA-58-like, class D) are considered to be responsible for the worldwide resistance epidemics. As compared with monotherapy with colistin or tigecycline, combination therapy has been shown to effectively lower case-fatality rates. However, development of new antibiotics is crucial in the present pandrug-resistant era.
碳青霉烯酶具有对β-内酰胺类广泛的水解能力，现已成为革兰氏阴性菌耐药的重要原因。编码获得性碳青霉烯酶的基因具有很高的传播潜力。此外，由产获得性碳青霉烯酶的革兰氏阴性菌引起的感染会导致很高的临床死亡率。在获得性碳青霉烯酶中，肺炎克雷伯菌碳青霉烯酶（安布勒A类）、维罗纳整合子编码金属β-内酰胺酶（安布勒B类）、新德里金属β-内酰胺酶（安布勒B类）以及许多OXA酶（OXA-23样、OXA-24样、OXA-48样、OXA-58样，D类）被认为是全球耐药流行的原因。与使用黏菌素或替加环素单药治疗相比，联合治疗已被证明可有效降低病死率。然而，在当前全耐药时代，开发新抗生素至关重要。
