WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden.
Department of Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
Nat Rev Urol. 2017 Mar;14(3):139-152. doi: 10.1038/nrurol.2016.268. Epub 2017 Jan 10.
The emergence of antimicrobial resistance (AMR) is a major concern worldwide and already compromises treatment effectiveness and control of several bacterial sexually transmitted infections (STIs). Neisseria gonorrhoeae and Mycoplasma genitalium are evolving into so-called superbugs that can become resistant, both in vitro and clinically, to essentially all antimicrobials available for treatment, causing exceedingly difficult-to-treat or untreatable STIs and threatening global public health. Widespread AMR in these bacteria is likely to persist and even worsen in the future, owing to the high number of infections, widespread and uncontrolled use of antimicrobials, limited surveillance of AMR and clinical failures, as well as the extraordinary capacity of these bacteria to develop AMR. This development would not only result in an increased prevalence of N. gonorrhoeae and M. genitalium infections but also in a considerably increasing number of severe complications affecting reproductive health. To combat this threat, clinicians need to be aware of the current guidelines on diagnostic procedures, recommended treatment regimens, as well as therapeutic options for multidrug-resistant bacteria. AMR testing needs to be more frequently performed, inform treatment decisions and elucidate how AMRs compromise treatment effectiveness, guiding research for effective future therapies.
抗菌药物耐药性（AMR）的出现是一个全球性的主要关注点，已经影响了几种细菌性性传播感染（STIs）的治疗效果和控制。淋病奈瑟菌和生殖支原体正在演变成所谓的超级细菌，它们在体外和临床上对几乎所有可用于治疗的抗菌药物都具有耐药性，导致极难治疗或无法治疗的 STIs，并威胁着全球公共卫生。由于感染数量众多、抗菌药物广泛且不受控制地使用、对 AMR 的监测和临床治疗失败有限，以及这些细菌具有极强的产生 AMR 的能力，这些细菌中的广泛 AMR 很可能在未来持续存在甚至恶化。这种发展不仅会导致淋病奈瑟菌和生殖支原体感染的流行率增加，还会导致越来越多的严重影响生殖健康的并发症。为了应对这一威胁，临床医生需要了解当前关于诊断程序、推荐治疗方案以及多药耐药菌治疗选择的指南。需要更频繁地进行 AMR 检测，以告知治疗决策，并阐明 AMR 如何影响治疗效果，指导未来有效的治疗研究。
