Jacoby G A
Infectious Disease Unit, Massachusetts General Hospital, Boston.
Clin Infect Dis. 1994 Jun;18(6):951-7. doi: 10.1093/clinids/18.6.951.
Organisms causing common infections of the respiratory tract are becoming increasingly resistant to antimicrobial agents. In 1990-1991 between 15% and 20% of isolates of Streptococcus pneumoniae from the United States had MICs of penicillin G of > or = 0.1 microgram/mL and 2%-3% had MICs of > or = 1.0 microgram/mL. The percentage of isolates that are resistant is even higher in other parts of the world. Although most penicillin-resistant strains of S. pneumoniae are susceptible to broad-spectrum cephalosporins, a few isolates resistant to cefuroxime, cefotaxime, and ceftriaxone have appeared. Unlike other respiratory pathogens in which the production of beta-lactamase is responsible for resistance, S. pneumoniae exhibits resistance that is caused by alterations in penicillin-binding proteins. Consequently, beta-lactam/beta-lactamase inhibitor combinations have no particular value against resistant pneumococci. Furthermore, penicillin-resistant pneumococci are often coresistant to macrolides, sulfa-based drugs, and tetracycline. Knowledge of how resistance is attained presumably will further the development of new strategies for treatment. The mechanisms of resistance of pneumococci and other common respiratory pathogens (particularly Haemophilus influenzae and Moraxella catarrhalis) to standard antimicrobial agents are examined in this report.
引起呼吸道常见感染的病原体对抗菌药物的耐药性日益增强。在1990 - 1991年期间，从美国分离出的肺炎链球菌中，有15%至20%的菌株对青霉素G的最低抑菌浓度（MIC）≥0.1微克/毫升，2%至3%的菌株对青霉素G的MIC≥1.0微克/毫升。在世界其他地区，耐药菌株的比例甚至更高。尽管大多数耐青霉素的肺炎链球菌菌株对广谱头孢菌素敏感，但已出现了一些对头孢呋辛、头孢噻肟和头孢曲松耐药的菌株。与其他因产生β-内酰胺酶而耐药的呼吸道病原体不同，肺炎链球菌的耐药性是由青霉素结合蛋白的改变引起的。因此，β-内酰胺/β-内酰胺酶抑制剂联合用药对耐药肺炎球菌没有特别的价值。此外，耐青霉素的肺炎球菌通常对大环内酯类、磺胺类药物和四环素也耐药。了解耐药性的产生机制可能会推动新治疗策略的开发。本报告研究了肺炎球菌及其他常见呼吸道病原体（特别是流感嗜血杆菌和卡他莫拉菌）对标准抗菌药物的耐药机制。
