Rizvanov Albert A, Haertlé Thomas, Bogomolnaya Lydia, Talebi Bezmin Abadi Amin
Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
Biopolymers Interactions Assemblies, Institut National de la Recherche Agronomique, Nantes, France.
Front Microbiol. 2019 Aug 13;10:1796. doi: 10.3389/fmicb.2019.01796. eCollection 2019.
"Heteroresistance" is a widely applied term that characterizes most of the multidrug-resistant microorganisms. In microbiological practice, the word "heteroresistance" indicates diverse responses to specific antibiotics by bacterial subpopulations in the same patient. These resistant subpopulations of heteroresistant strains do not respond to antibiotic therapy or . Presently, there is no standard protocol available for the treatment of infections caused by heteroresistant in clinical settings, at least according to recent guidelines. Thus, there is a definite need to open a new discussion on how to recognize, how to screen, and how to eliminate those problematic strains in clinical and environmental samples. Since there is great interest in developing new strategies to improve the eradication rate of anti- treatments, the presence of heteroresistant strains/clones among clinical isolates of the bacteria should be taken into account. Indeed, increased knowledge of gastroenterologists about the existence of heteroresistance phenomena is highly required. Moreover, the accurate breakpoints should be examined/determined in order to have a solid statement of heteroresistance among the isolates. The primary definition of heteroresistance was about coexistence of both resistant and susceptible isolates at the similar gastric microniche at once, while we think that it can be happened subsequently as well. The new guidelines should include a personalized aspect in the standard protocol to select a precise, effective antibiotic therapy for infected patients and also address the problems of regional antibiotic susceptibility profiles.
“异质性耐药”是一个广泛应用的术语，用于描述大多数多重耐药微生物。在微生物学实践中，“异质性耐药”一词表示同一患者体内细菌亚群对特定抗生素的不同反应。这些异质性耐药菌株的耐药亚群对抗生素治疗无反应。目前，至少根据最近的指南，临床上尚无治疗由异质性耐药菌引起感染的标准方案。因此，确实有必要就如何在临床和环境样本中识别、筛选和消除这些有问题的菌株展开新的讨论。由于人们对开发提高抗治疗根除率的新策略非常感兴趣，因此应考虑细菌临床分离株中异质性耐药菌株/克隆的存在。事实上，胃肠病学家对异质性耐药现象存在的认识亟需提高。此外，应检查/确定准确的断点，以便对分离株中的异质性耐药有确凿的说明。异质性耐药的最初定义是耐药和敏感分离株在相似的胃微环境中同时共存，而我们认为随后也可能发生这种情况。新指南应在标准方案中纳入个性化因素，为感染患者选择精确、有效的抗生素治疗，并解决区域抗生素敏感性谱的问题。
