Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Graduate School of Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
Eur J Clin Microbiol Infect Dis. 2023 Mar;42(3):229-254. doi: 10.1007/s10096-023-04548-2. Epub 2023 Jan 21.
The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens-especially Escherichia coli and Klebsiella pneumoniae-may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.
产超广谱β-内酰胺酶（ESBL）和/或碳青霉烯酶肠杆菌科（Ent）导致的感染的临床影响在全球范围内已达到显著水平。这些多药耐药（MDR）病原体（尤其是大肠杆菌和肺炎克雷伯菌）引起的感染可能源自先前无症状的肠道定植，这也可能有利于向其他个体传播。因此，迅速识别肠道携带者以尝试预防严重的内源性感染和潜在传播是可取的。除了感染预防和控制措施外，还需要能够有效从肠道清除 MDR-Ent 的任何策略。在这篇叙述性综述中，我们总结了与 MDR-Ent 肠道定植相关的不同方面。特别是，我们将介绍基于培养和分子的筛查技术来识别携带者，不同人群中的流行率和危险因素数据，临床影响，定植时间以及在各种情况下对传播的贡献。我们还将讨论可能用于清除 MDR-Ent 携带者的标准策略（选择性消化道去污染、粪便微生物移植）和仍在开发中的策略（噬菌体、益生菌、微菌素和基于 CRISPR-Cas 的策略）。
