El Moujaber Grace, Osman Marwan, Rafei Rayane, Dabboussi Fouad, Hamze Monzer
Laboratoire Microbiologie Santé et Environnement (LMSE), Ecole Doctorale des Sciences et de Technologie, Faculté de Santé Publique, Université Libanaise, Tripoli, Lebanon.
J Med Microbiol. 2017 Jul;66(7):847-858. doi: 10.1099/jmm.0.000503. Epub 2017 Jun 26.
Streptococcus pneumoniae is a commensal bacterium that normally colonizes the human nasopharyngeal cavity. Once disseminated, it can cause several diseases, ranging from non-invasive infections such as acute otitis media and sinusitis through to invasive infections with higher mortality, including meningitis and septicaemia. Since the identification of the first S. pneumoniae strain with decreased susceptibility to penicillin in the 1960s, antibiotic resistance among S. pneumoniae has increased disturbingly and the mechanisms of resistance have begun to unfold.
This work briefly reviewed the available data on the molecular mechanisms underlying antimicrobial resistance and its epidemiology among pneumococcal strains in Middle Eastern countries.
Both intrinsic and acquired mechanisms (mutations, acquisition of novel mobile genetic elements and sometimes gene duplication and overexpression) affect susceptibility to a large variety of antibiotics. In Middle Eastern countries, including Lebanon, Iran, Saudi Arabia and Turkey, surveillance showed a disturbing increase in the strength and prevalence of resistance to antibiotics over the years, especially in the last decade. However, no surveillance reports were found in other Middle Eastern countries, such as Syria and Iraq.
In order to better survey, control and prevent the emergence of multidrug- and extremely drug-resistant S. pneumoniae strains, antimicrobial stewardship, national surveillance and public awareness programmes should be developed urgently in Middle Eastern countries.
肺炎链球菌是一种共生细菌，通常定殖于人类鼻咽腔。一旦扩散，它可引发多种疾病，从非侵袭性感染如急性中耳炎和鼻窦炎到死亡率更高的侵袭性感染，包括脑膜炎和败血症。自20世纪60年代首次鉴定出对青霉素敏感性降低的肺炎链球菌菌株以来，肺炎链球菌的抗生素耐药性令人不安地增加，且耐药机制已开始显现。
这项工作简要回顾了中东国家肺炎球菌菌株中抗菌药物耐药性的分子机制及其流行病学的现有数据。
固有机制和获得性机制（突变、获得新的可移动遗传元件，有时还有基因复制和过表达）都会影响对多种抗生素的敏感性。在包括黎巴嫩、伊朗、沙特阿拉伯和土耳其在内的中东国家，监测显示多年来抗生素耐药性的强度和流行率令人不安地增加，尤其是在过去十年。然而，在其他中东国家，如叙利亚和伊拉克，未发现监测报告。
为了更好地监测、控制和预防多重耐药和极耐药肺炎链球菌菌株的出现，中东国家应紧急制定抗菌药物管理、国家监测和公众意识计划。
