Laboratoire de Bactériologie, Institut de Biologie en Santé - PBH, CHU Angers, Angers, France.
HIFIH Laboratory UPRES EA3859, SFR ICAT 4208, Angers University, Angers, France.
Eur Respir Rev. 2022 May 25;31(164). doi: 10.1183/16000617.0259-2021. Print 2022 Jun 30.
The development of resistome analysis, the comprehensive analysis of antibiotic-resistance genes (ARGs), is enabling a better understanding of the mechanisms of antibiotic-resistance emergence. The respiratory microbiome is a dynamic and interactive network of bacteria, with a set of ARGs that could influence the response to antibiotics. Viruses such as bacteriophages, potential carriers of ARGs, may also form part of this respiratory resistome. Chronic respiratory diseases (CRDs) such as cystic fibrosis, severe asthma, chronic obstructive pulmonary disease and bronchiectasis, managed with long-term antibiotic therapies, lead to multidrug resistance. Antibiotic susceptibility testing provides a partial view of the bacterial response to antibiotics in the complex lung environment. Assessing the ARG network would allow personalised, targeted therapeutic strategies and suitable antibiotic stewardship in CRDs, depending on individual resistome and microbiome signatures. This review summarises the influence of pulmonary antibiotic protocols on the respiratory microbiome, detailing the variable consequences according to antibiotic class and duration of treatment. The different resistome-profiling methods are explained to clarify their respective place in antibiotic-resistance analysis in the lungs. Finally, this review details current knowledge on the respiratory resistome related to therapeutic strategies and provides insight into the application of resistome analysis to counter the emergence of multidrug-resistant respiratory pathogens.
耐药组分析的发展，即抗生素耐药基因 (ARGs) 的综合分析，使人们能够更好地理解抗生素耐药性产生的机制。呼吸道微生物组是一个动态的、相互作用的细菌网络，其中存在一组可能影响抗生素反应的 ARGs。噬菌体等病毒，可能是 ARGs 的潜在载体，也可能成为这个呼吸耐药组的一部分。慢性呼吸道疾病 (CRD) ，如囊性纤维化、严重哮喘、慢性阻塞性肺疾病和支气管扩张症，需要长期的抗生素治疗，导致多药耐药。抗生素药敏试验提供了细菌在复杂肺部环境中对抗生素反应的部分情况。评估 ARG 网络将允许根据个体耐药组和微生物组特征，为 CRD 制定个性化、靶向的治疗策略和合适的抗生素管理。这篇综述总结了肺部抗生素方案对呼吸道微生物组的影响，详细说明了根据抗生素种类和治疗持续时间的不同，其后果也不同。解释了不同的耐药组分析方法，以阐明它们在肺部抗生素耐药性分析中的各自位置。最后，本综述详细介绍了与治疗策略相关的呼吸道耐药组的现有知识，并深入探讨了耐药组分析在对抗多药耐药呼吸道病原体方面的应用。
