The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia.
Division of Infectious Diseases, National University Health System, 1E Kent Ridge Road, 119228, Singapore.
Nat Rev Urol. 2015 Oct;12(10):570-84. doi: 10.1038/nrurol.2015.199. Epub 2015 Sep 1.
Antibiotic resistance in Gram-negative uropathogens is a major global concern. Worldwide, the prevalence of Enterobacteriaceae that produce extended-spectrum β-lactamase or carbapenemase enzymes continues to increase at alarming rates. Likewise, resistance to other antimicrobial agents including aminoglycosides, sulphonamides and fluoroquinolones is also escalating rapidly. Bacterial resistance has major implications for urological practice, particularly in relation to catheter-associated urinary tract infections (UTIs) and infectious complications following transrectal-ultrasonography-guided biopsy of the prostate or urological surgery. Although some new drugs with activity against Gram-negative bacteria with highly resistant phenotypes will become available in the near future, the existence of a single agent with activity against the great diversity of resistance is unlikely. Responding to the challenges of Gram-negative resistance will require a multifaceted approach including considered use of current antimicrobial agents, improved diagnostics (including the rapid detection of resistance) and surveillance, better adherence to basic measures of infection prevention, development of new antibiotics and research into non-antibiotic treatment and preventive strategies.
革兰氏阴性尿路病原体的抗生素耐药性是一个全球性的主要关注点。在全球范围内，产生扩展谱β-内酰胺酶或碳青霉烯酶的肠杆菌科的流行率以惊人的速度持续上升。同样，对其他抗菌药物的耐药性，包括氨基糖苷类、磺胺类和氟喹诺酮类药物，也在迅速加剧。细菌耐药性对泌尿科实践有重大影响，特别是与导管相关的尿路感染（UTI）以及经直肠超声引导前列腺或泌尿科手术后的感染性并发症有关。尽管未来不久将有一些具有高度耐药表型的革兰氏阴性细菌活性的新药问世，但不太可能有一种药物对如此多样化的耐药性具有活性。应对革兰氏阴性耐药性的挑战需要采取多方面的方法，包括谨慎使用现有的抗菌药物、改进诊断（包括快速检测耐药性）和监测、更好地遵守感染预防的基本措施、开发新的抗生素以及研究非抗生素治疗和预防策略。
