Schaberg D R, Rubens C E, Alford R H, Farrar W E, Schaffner W, McGee Z A
Am J Med. 1981 Feb;70(2):445-8. doi: 10.1016/0002-9343(81)90786-5.
The development of antimicrobial resistance by bacteria has had profound effects of the clinical use of antibiotics, especially in hospital-acquired infections. In 1973, a large outbreak of nosocomial infections due to Serratia marcescens began at the Vanderbilt University medical complex, a major characteristic of which was high-level resistance to gentamicin and carbenicillin. Investigation of the outbreak and subsequent in vitro studies have shown that the evolution and epidemiology of this high-level resistance operated at three levels of organizations: (1) dissemination of individual strains, (2) dissemination of a plasmid among different strains and (3) movement of a discrete genetic element, or transposon, between plasmids. The investigations of this outbreak and other studies reviewed support the concept that resistant strains can evoke as a result of R-plasmid exchange within the hospital environment, providing an opportunity for control of this exchange can be interrupted.
细菌对抗菌药物耐药性的发展已对抗生素的临床应用产生了深远影响，尤其是在医院获得性感染方面。1973年，范德比尔特大学医学中心爆发了由粘质沙雷氏菌引起的大规模医院感染，其一个主要特征是对庆大霉素和羧苄青霉素具有高度耐药性。对此次疫情的调查以及随后的体外研究表明，这种高度耐药性的演变和流行病学在三个组织层面发挥作用：（1）单个菌株的传播，（2）质粒在不同菌株间的传播，以及（3）离散遗传元件或转座子在质粒间的移动。对此次疫情的调查以及所回顾的其他研究支持了这样一种观点，即耐药菌株可因医院环境中的R质粒交换而产生，这为控制这种交换提供了一个机会，只要这种交换能够被阻断。
