Department of Medical Microbiology, Medical University of Sofia , Sofia , Bulgaria.
Specialized Hospital for Active Pediatric Treatment, Medical University of Sofia , Sofia , Bulgaria.
Expert Rev Clin Pharmacol. 2019 Sep;12(9):909-915. doi: 10.1080/17512433.2019.1654858. Epub 2019 Aug 28.
: antibiotic resistance has increased worldwide and multidrug resistance (MDR), which seriously hampers eradication success of the frequent chronic infection, has often been reported. : MDR rates are discussed, mostly from recent articles published since 2015. Present approaches and future directions to counteract the MDR are outlined. : Alarming presence of triple, quadruple and, in some studies, quintuple and sextuple resistance was detected. Primary MDR rates ranged from <10% in most European countries to >40% in Peru. Post-treatment or overall MDR rates were >23-36% in about half of the studies. MDR prevalence has varied both among and within the countries. Factors linked to the MDR are national antibiotic consumption, antibiotic misuse, treatment failures and bacterial factors such as mutations, efflux pumps, and biofilms. Important directions to counteract the MDR increase can be optimization of present and new eradication regimens, wider use of bismuth-containing regimens, assessment of benefit of vonoprazan, new antibiotics such as newer fluoroquinolones and oxazolidinone analogues, adjuvants involving N-acetylcysteine and probiotics, anti-biofilm approaches using anti-biofilm peptides and rhamnolipid and development of vaccines and non-invasive tests for resistance detection. However, more efforts and studies are required. Strain susceptibility testing is increasingly important.
: 抗生素耐药性在全球范围内不断增加，多重耐药性（MDR）严重阻碍了这种频繁的慢性感染的根除成功率，这种情况经常被报道。 : 本文讨论了 MDR 率，主要来自 2015 年以来发表的最近的文章。概述了目前对抗 MDR 的方法和未来方向。 : 令人震惊的是，检测到了三重、四重耐药，在一些研究中，甚至还检测到了五重和六重耐药。原发性 MDR 率在大多数欧洲国家<10%，而在秘鲁则>40%。在大约一半的研究中，治疗后或总体 MDR 率>23-36%。MDR 的流行率在国家之间和国家内部都有所不同。与 MDR 相关的因素包括国家抗生素消费、抗生素滥用、治疗失败以及细菌因素，如突变、外排泵和生物膜。可以采取以下重要措施来对抗 MDR 的增加：优化现有的和新的根除方案、更广泛地使用含铋方案、评估 vonoprazan 的益处、新型抗生素，如新型氟喹诺酮类和恶唑烷酮类似物、涉及 N-乙酰半胱氨酸和益生菌的佐剂、使用抗生物膜肽和鼠李糖脂的抗生物膜方法以及开发疫苗和非侵入性耐药检测方法。然而，还需要更多的努力和研究。菌株敏感性测试变得越来越重要。
