Bedenić Branka, Pospišil Mladen, Nađ Marina, Bandić Pavlović Daniela
Biomedical Research Center Šalata, University of Zagreb School of Medicine, Department for Clinical Microbiology and Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Department of Emergency Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Microorganisms. 2025 Feb 25;13(3):508. doi: 10.3390/microorganisms13030508.
The management of infectious diseases has proven to be a daunting task for clinicians worldwide, and the rapid development of antibiotic resistance among Gram-negative bacteria is making it even more challenging. The first-line therapy is empirical, and it most often comprises β-lactam antibiotics. Among Gram-negative bacteria, , an important community and hospital pathogen associated primarily with urinary tract and wound infection, holds a special place. This review's aim was to collate and examine recent studies investigating β-lactam resistance phenotypes and mechanisms of species and the global significance of its β-lactam resistance evolution. Moreover, the genetic background of resistance traits and the role of mobile genetic elements in the dissemination of resistance genes were evaluated. as the dominant pathogen develops resistance to expanded-spectrum cephalosporins (ESC) by producing extended-spectrum β-lactamases (ESBL) and plasmid-mediated AmpC β-lactamases (p-AmpC). β-lactamase-mediated resistance to carbapenems in , including spp., is mostly due to expression of carbapenemases of class A (KPC); class B (metallo-β-lactamases or MBLs of IMP, VIM, or NDM series); or class D or carbapenem-hydrolyzing oxacillinases (CHDL). Previously, a dominant ESBL type in was TEM-52; yet, lately, it has been replaced by CTX-M variants, particularly CTX-M-14. ESC resistance can also be mediated by p-AmpC, with CMY-16 as the dominant variant. Carbapenem resistance in spp. is a challenge due to its intrinsic resistance to colistin and tigecyclin. The first carbapenemases reported belonged to class B, most frequently VIM-1 and NDM-5. In Europe, predominantly France and Belgium, a clonal lineage positive for OXA-23 CHDL spreads rapidly undetected, due to its low-level resistance to carbapenems. The amazing capacity of spp. to accumulate a plethora of various resistance traits is leading to multidrug or extensively drug-resistant phenotypes.
事实证明，对全球临床医生来说，传染病管理是一项艰巨的任务，革兰氏阴性菌中抗生素耐药性的迅速发展使其更具挑战性。一线治疗是经验性的，最常用的是β-内酰胺类抗生素。在革兰氏阴性菌中，作为主要与尿路感染和伤口感染相关的重要社区和医院病原体，占有特殊地位。本综述的目的是整理和研究最近关于该菌β-内酰胺耐药表型和机制及其β-内酰胺耐药性进化的全球意义的研究。此外，还评估了耐药性状的遗传背景以及移动遗传元件在耐药基因传播中的作用。随着主要病原体通过产生超广谱β-内酰胺酶（ESBL）和质粒介导的AmpCβ-内酰胺酶（p-AmpC）对超广谱头孢菌素（ESC）产生耐药性。该菌中由β-内酰胺酶介导的对碳青霉烯类的耐药性，包括某些菌株，主要是由于A类碳青霉烯酶（KPC）；B类（金属β-内酰胺酶或IMP、VIM或NDM系列的MBL）；或D类或碳青霉烯水解氧青霉烯酶（CHDL）的表达。以前，该菌中占主导地位的ESBL类型是TEM-52；然而，最近它已被CTX-M变体取代，特别是CTX-M-14。ESC耐药性也可由p-AmpC介导，CMY-16是主要变体。某些菌株对碳青霉烯类的耐药性是一个挑战，因为其对黏菌素和替加环素具有固有耐药性。报道的首批碳青霉烯酶属于B类，最常见的是VIM-1和NDM-5。在欧洲，主要是法国和比利时，一种对OXA-23 CHDL呈阳性的克隆谱系由于对碳青霉烯类的低水平耐药性而未被察觉地迅速传播。该菌积累大量各种耐药性状的惊人能力正导致多药耐药或广泛耐药表型。
