Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
Infect Genet Evol. 2018 Jul;61:185-188. doi: 10.1016/j.meegid.2018.04.005. Epub 2018 Apr 5.
The worldwide spread of extended-spectrum β-lactamase (ESBL)-producing bacteria, particularly Escherichia coli and Klebsiella pneumoniae, is a critical concern for the development of therapies against multidrug-resistant bacteria. Since the 2000s, detection rates of CTX-M types ESBL-producing E. coli in the community have been high, possibly contributing to their nosocomial detection. Various factors, such as environmental sources, food animals, and international travel, accelerate the global ESBL spread in the community. The dramatic dissemination of ESBLs in the community is associated with the relatively recent emergence of CTX-M-15-producing ST131 E. coli clones, which often carry many other antibiotic resistance genes (including quinolone). The usefulness of β-lactam/β-lactamase inhibitor, particularly, piperacillin/tazobactam, has been considered as a carbapenem-sparing regimen for ESBL infections, although the global trend of AmpC β-lactamase-producing bacteria should be monitored carefully. Careful therapeutic selection and continued surveillance for the detection of multidrug-resistant bacteria are required.
全球范围内，产Extended-spectrum β-lactamase (ESBL)的细菌（尤其是大肠埃希菌和肺炎克雷伯菌）的传播，是治疗多重耐药菌感染的一个重大挑战。自 21 世纪以来，社区中产 CTX-M 型 ESBL 的大肠埃希菌的检出率一直居高不下，这可能是其在医院内检出的原因之一。环境来源、食用动物和国际旅行等各种因素加速了社区中 ESBL 的全球传播。社区中 ESBL 的广泛传播与 CTX-M-15 型大肠埃希菌 ST131 克隆的相对近期出现有关，这些克隆通常携带许多其他抗生素耐药基因（包括喹诺酮）。β-内酰胺/β-内酰胺酶抑制剂（特别是哌拉西林/他唑巴坦）的使用被认为是 ESBL 感染的碳青霉烯类药物节约方案，尽管应密切监测全球产 AmpC 型β-内酰胺酶的细菌的趋势。需要仔细选择治疗药物并持续监测耐药菌的检出。
