Munita Jose M, Bayer Arnold S, Arias Cesar A
Division of Infectious Diseases, Department of Internal Medicine International Center for Microbial Genomics Clinica Alemana de Santiago, Universidad del Desarrollo, Chile.
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance David Geffen School of Medicine at UCLA, Los Angeles, California.
Clin Infect Dis. 2015 Sep 15;61 Suppl 2(Suppl 2):S48-57. doi: 10.1093/cid/civ523.
Antimicrobial therapy is a key component of modern medical practice and a cornerstone for the development of complex clinical interventions in critically ill patients. Unfortunately, the increasing problem of antimicrobial resistance is now recognized as a major public health threat jeopardizing the care of thousands of patients worldwide. Gram-positive pathogens exhibit an immense genetic repertoire to adapt and develop resistance to virtually all antimicrobials clinically available. As more molecules become available to treat resistant gram-positive infections, resistance emerges as an evolutionary response. Thus, antimicrobial resistance has to be envisaged as an evolving phenomenon that demands constant surveillance and continuous efforts to identify emerging mechanisms of resistance to optimize the use of antibiotics and create strategies to circumvent this problem. Here, we will provide a broad perspective on the clinical aspects of antibiotic resistance in relevant gram-positive pathogens with emphasis on the mechanistic strategies used by these organisms to avoid being killed by commonly used antimicrobial agents.
抗菌治疗是现代医学实践的关键组成部分，也是重症患者复杂临床干预措施发展的基石。不幸的是，日益严重的抗菌药物耐药性问题现已被公认为是一项重大的公共卫生威胁，危及全球数千名患者的治疗。革兰氏阳性病原体展现出巨大的基因库，能够适应并对几乎所有临床可用的抗菌药物产生耐药性。随着越来越多的分子可用于治疗耐药革兰氏阳性感染，耐药性作为一种进化反应而出现。因此，必须将抗菌药物耐药性视为一种不断演变的现象，需要持续监测并不断努力识别新出现的耐药机制，以优化抗生素的使用并制定应对这一问题的策略。在此，我们将全面阐述相关革兰氏阳性病原体抗生素耐药性的临床方面，重点关注这些病原体用于避免被常用抗菌药物杀死的机制策略。
