Fuzi Miklos
Institute of Medical Microbiology, Semmelweis University Budapest, Hungary.
Front Microbiol. 2016 Jul 7;7:1017. doi: 10.3389/fmicb.2016.01017. eCollection 2016.
Fitness cost associated with resistance to fluoroquinolones was recently shown to vary across clones of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing Klebsiella pneumoniae. The resulting dissimilar fitness should have influenced the clonal dynamics and thereby the rates of resistance for these pathogens. Moreover, a similar mechanism was recently proposed for the emergence of the H30 and H30R lineages of ESBL-producing E. coli and the major international clone (ribotype 027) of Clostridium difficile. Furthermore, several additional international clones of various multiresistant bacteria are suspect to have been selected by an analogous process. An ability to develop favorable mutations in the gyrase and topoisomerase IV genes seems to be a prerequisite for pathogens to retain fitness while showing high-level resistance to fluoroquinolones. Since, the consumption of other "non-fluoroquinolone" groups of antibiotics have also contributed to the rise in resistance rates a more judicious use of antibiotics in general and of fluoroquinolones in particular could ameliorate the international resistance situation.
最近研究表明，耐氟喹诺酮类药物的适应性代价在耐甲氧西林金黄色葡萄球菌和产超广谱β-内酰胺酶肺炎克雷伯菌的不同克隆中存在差异。由此产生的不同适应性应该会影响克隆动态，进而影响这些病原体的耐药率。此外，最近有人提出，产超广谱β-内酰胺酶大肠杆菌的H30和H30R谱系以及艰难梭菌的主要国际克隆（核糖体分型027）的出现也有类似机制。此外，几种多耐药细菌的其他国际克隆也被怀疑是通过类似过程被选择出来的。在gyrase和拓扑异构酶IV基因中产生有利突变的能力似乎是病原体在对氟喹诺酮类药物表现出高水平耐药性的同时保持适应性的先决条件。由于其他“非氟喹诺酮”类抗生素的使用也导致了耐药率的上升，总体上更明智地使用抗生素，尤其是氟喹诺酮类药物，可以改善国际耐药状况。
