Neu H C
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Am J Surg. 1995 May;169(5A Suppl):13S-20S.
Antimicrobial resistance is commonplace among bacteria involved in surgical infections, including Staphylococcus aureus, enterococci, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Bacteroides species. Resistance traits can be encoded on chromosomes or transmissible plasmids. The basic mechanisms of resistance are alteration of drug target, prevention of drug access to target, and drug inactivation. Examples include alteration of penicillin-binding proteins in resistance to penicillinase-resistant penicillins, ribosomal binding site protection in tetracycline resistance, and beta-lactamase destruction of beta-lactam compounds. Resistance due to the many types of beta-lactamases that have thus far been identified is wide-spread among common pathogens; use of beta-lactam/beta-lactamase inhibitor combinations has proved effective as one means of counteracting such resistance. Contending with resistance involves appropriate use of available antimicrobials, development of novel agents or modification of existing agents, and measures to forestall emergence and spread of resistant organisms.
抗菌药物耐药性在外科感染相关细菌中很常见，包括金黄色葡萄球菌、肠球菌、大肠杆菌、肺炎克雷伯菌、阴沟肠杆菌和拟杆菌属。耐药性状可由染色体或可传递质粒编码。耐药的基本机制包括药物靶点改变、阻止药物到达靶点以及药物失活。例如，对耐青霉素酶青霉素耐药时青霉素结合蛋白的改变、对四环素耐药时核糖体结合位点的保护以及β-内酰胺化合物的β-内酰胺酶破坏。由于迄今已鉴定出的多种β-内酰胺酶导致的耐药性在常见病原体中广泛存在；事实证明，使用β-内酰胺/β-内酰胺酶抑制剂联合用药是对抗此类耐药性的一种有效方法。应对耐药性涉及合理使用现有抗菌药物、开发新型药物或对现有药物进行改良，以及采取措施防止耐药菌的出现和传播。
