Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
J Antimicrob Chemother. 2018 Jan 1;73(1):1-11. doi: 10.1093/jac/dkx349.
Daptomycin is a cyclic lipopeptide antibiotic used for the treatment of Gram-positive infections including complicated skin and skin structure infections, right-sided infective endocarditis, bacteraemia, meningitis, sepsis and urinary tract infections. Daptomycin has distinct mechanisms of action, disrupting multiple aspects of cell membrane function and inhibiting protein, DNA and RNA synthesis. Although daptomycin resistance in Gram-positive bacteria is uncommon, there are increasing reports of daptomycin resistance in Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis. Such resistance is seen largely in the context of prolonged treatment courses and infections with high bacterial burdens, but may occur in the absence of prior daptomycin exposure. Furthermore, use of inadequate treatment regimens, irregular drug supply and poor drug quality have also been recognized as other important risk factors for emergence of daptomycin-resistant strains. Antimicrobial susceptibility testing of Gram-positive bacteria, communication between clinicians and laboratories, establishment of internet-based reporting systems, development of better and more rapid diagnostic methods and continuous monitoring of drug resistance are urgent priorities.
达托霉素是一种环脂肽类抗生素，用于治疗革兰阳性感染，包括复杂性皮肤和皮肤结构感染、右侧感染性心内膜炎、菌血症、脑膜炎、败血症和尿路感染。达托霉素具有独特的作用机制，可破坏细胞膜功能的多个方面，并抑制蛋白质、DNA 和 RNA 的合成。虽然革兰阳性菌中的达托霉素耐药性并不常见，但越来越多的报告显示金黄色葡萄球菌、屎肠球菌和粪肠球菌中存在达托霉素耐药性。这种耐药性主要见于长时间治疗和高细菌负荷的感染，但也可能在没有先前达托霉素暴露的情况下发生。此外，不适当的治疗方案、药物供应不规律和药物质量差也被认为是达托霉素耐药菌株出现的其他重要危险因素。革兰阳性菌的药敏试验、临床医生和实验室之间的沟通、建立基于互联网的报告系统、开发更好和更快的诊断方法以及对耐药性的持续监测是当务之急。
