Appel Tobias M, Vehreschild Maria J
Zentrum für Innere Medizin, Medizinische Klinik 2, Infektiologie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
Inn Med (Heidelb). 2022 Oct;63(10):1043-1050. doi: 10.1007/s00108-022-01400-1. Epub 2022 Sep 1.
Antimicrobial resistance (AR) is a natural phenomenon resulting from the exposure of bacteria to antibacterial substances. The intestinal microbiome plays a central role in the development and transmission of AR. In its physiological state, the intestinal microbiome has several mechanisms that contribute to what is referred to as colonization resistance against potentially pathogenic and often multiresistant bacteria. Exposure to broad-spectrum antibiotics can disrupt those mechanisms, facilitating colonization with these pathogens. The persistence of antibiotic selection pressure favors growth of multiresistant bacteria and their dominance within the intestinal microbiota. Under these circumstances, the risk of the development of invasive infections increases. Antibiotic stewardship programs, the use of narrow-spectrum antibiotics, and the administration of substances that protect the intestinal microbiome from antibiotic exposure can prevent these processes. Several interventions such as the administration of probiotics, oral antibiotics, and fecal microbiome transfers are potential strategies for decolonizing patients with multidrug resistant bacteria; to date, however, no intervention has been proven to be consistently effective.
抗菌药物耐药性（AR）是细菌接触抗菌物质后产生的一种自然现象。肠道微生物群在AR的发生和传播中起着核心作用。在其生理状态下，肠道微生物群有多种机制有助于对潜在致病性且通常具有多重耐药性的细菌产生所谓的定植抗性。接触广谱抗生素会破坏这些机制，从而促进这些病原体的定植。抗生素选择压力的持续存在有利于多重耐药细菌的生长及其在肠道微生物群中的优势地位。在这种情况下，发生侵袭性感染的风险会增加。抗生素管理计划、使用窄谱抗生素以及给予保护肠道微生物群免受抗生素暴露的物质可以预防这些过程。几种干预措施，如给予益生菌、口服抗生素和粪便微生物群移植，是使多重耐药菌患者去定植的潜在策略；然而，迄今为止，尚未证明任何一种干预措施始终有效。
