耐药机制:达托霉素耐药性
Mechanisms of drug resistance: daptomycin resistance.
作者信息
Tran Truc T, Munita Jose M, Arias Cesar A
机构信息
Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas.
International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.
出版信息
Ann N Y Acad Sci. 2015 Sep;1354:32-53. doi: 10.1111/nyas.12948. Epub 2015 Oct 23.
Daptomycin (DAP) is a cyclic lipopeptide with in vitro activity against a variety of Gram-positive pathogens, including multidrug-resistant organisms. Since its introduction into clinical practice in 2003, DAP has become an important key frontline antibiotic for severe or deep-seated infections caused by Gram-positive organisms. Unfortunately, DAP resistance (DAP-R) has been extensively documented in clinically important organisms such as Staphylococcus aureus, Enterococcus spp., and Streptococcus spp. Studies on the mechanisms of DAP-R in Bacillus subtilis and other Gram-positive bacteria indicate that the genetic pathways of DAP-R are diverse and complex. However, a common phenomenon emerging from these mechanistic studies is that DAP-R is associated with important adaptive changes in cell wall and cell membrane homeostasis with critical changes in cell physiology. Findings related to these adaptive changes have provided novel insights into the genetics and molecular mechanisms of bacterial cell envelope stress response and the manner in which Gram-positive bacteria cope with the antimicrobial peptide attack and protect vital structures of the cell envelope, such as the cell membrane. In this review, we will examine the most recent findings related to the molecular mechanisms of resistance to DAP in relevant Gram-positive pathogens and discuss the clinical implications for therapy against these important bacteria.
达托霉素(DAP)是一种环脂肽,对多种革兰氏阳性病原体具有体外活性,包括多重耐药菌。自2003年引入临床实践以来,达托霉素已成为治疗革兰氏阳性菌引起的严重或深部感染的重要一线抗生素。不幸的是,在金黄色葡萄球菌、肠球菌属和链球菌属等临床上重要的病原体中,广泛记录了对达托霉素的耐药性(DAP-R)。对枯草芽孢杆菌和其他革兰氏阳性菌中达托霉素耐药机制的研究表明,达托霉素耐药的遗传途径多样且复杂。然而,这些机制研究中出现的一个共同现象是,达托霉素耐药与细胞壁和细胞膜稳态的重要适应性变化以及细胞生理学的关键变化有关。与这些适应性变化相关的发现为细菌细胞壁应激反应的遗传学和分子机制以及革兰氏阳性菌应对抗菌肽攻击和保护细胞膜等细胞壁重要结构的方式提供了新的见解。在这篇综述中,我们将研究相关革兰氏阳性病原体中对达托霉素耐药分子机制的最新发现,并讨论针对这些重要细菌治疗的临床意义。