Xia Jufeng, Gao Jianjun, Tang Wei
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo.
Biosci Trends. 2016 Feb;10(1):14-21. doi: 10.5582/bst.2016.01020. Epub 2016 Feb 11.
Nosocomial infection is a kind of infection, which is spread in various hospital environments, and leads to many serious diseases (e.g. pneumonia, urinary tract infection, gastroenteritis, and puerperal fever), and causes higher mortality than community-acquired infection. Bacteria are predominant among all the nosocomial infection-associated pathogens, thus a large number of antibiotics, such as aminoglycosides, penicillins, cephalosporins, and carbapenems, are adopted in clinical treatment. However, in recent years antibiotic resistance quickly spreads worldwide and causes a critical threat to public health. The predominant bacteria include Methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. In these bacteria, resistance emerged from antibiotic resistant genes and many of those can be exchanged between bacteria. With technical advances, molecular mechanisms of resistance have been gradually unveiled. In this review, recent advances in knowledge about mechanisms by which (i) bacteria hydrolyze antibiotics (e.g. extended spectrum β-lactamases, (ii) AmpC β-lactamases, carbapenemases), (iii) avoid antibiotic targeting (e.g. mutated vanA and mecA genes), (iv) prevent antibiotic permeation (e.g. porin deficiency), or (v) excrete intracellular antibiotics (e.g. active efflux pump) are summarized.
医院感染是一种在各种医院环境中传播的感染，可导致许多严重疾病（如肺炎、尿路感染、肠胃炎和产褥热），并且其死亡率高于社区获得性感染。在所有与医院感染相关的病原体中，细菌占主导地位，因此临床治疗中采用了大量抗生素，如氨基糖苷类、青霉素类、头孢菌素类和碳青霉烯类。然而，近年来抗生素耐药性在全球迅速传播，对公众健康构成严重威胁。主要的细菌包括耐甲氧西林金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍曼不动杆菌。在这些细菌中，耐药性源于抗生素耐药基因，其中许多基因可在细菌之间交换。随着技术进步，耐药的分子机制已逐渐被揭示。在本综述中，总结了关于细菌（i）水解抗生素（如超广谱β-内酰胺酶）、（ii）AmpCβ-内酰胺酶、碳青霉烯酶、（iii）避免抗生素靶向（如vanA和mecA基因突变）、（iv）阻止抗生素渗透（如孔蛋白缺乏）或（v）排出细胞内抗生素（如主动外排泵）的机制的最新研究进展。
