French G L
Department of Microbiology, United Medical School, Guy's Hospital, London, United Kingdom.
Clin Infect Dis. 1998 Aug;27 Suppl 1:S75-83. doi: 10.1086/514910.
The frequency of infections with multiply antibiotic-resistant gram-positive bacteria is increasing, and in some cases these organisms remain susceptible only to the glycopeptides vancomycin and teicoplanin. The appearance of transferable high-level glycopeptide resistance in enterococci--producing some strains that are now resistant to all available antibiotics--is thus a cause for concern. The enterococci readily colonize the bowel, spread rapidly among hospital patients, and transfer their antibiotic resistances widely among themselves and other gram-positive species. Glycopeptide resistance has not yet transferred in vivo to other significant pathogens, but experimental transfer to Staphylococcus aureus has been achieved in vitro. The emergence of glycopeptide-resistant enterococci has been encouraged by the increasing use of aminoglycosides, cephalosporins, and quinolones for the treatment of infections due to gram-negative bacteria and glycopeptides for infections due to staphylococci and clostridium difficile. In Europe this antibiotic pressure has been aggravated by the use of the glycopeptide avoparcin in animal feeds. The enterococci may now be poised to disseminate glycopeptide resistance among other more pathogenic gram-positive bacteria.
多重耐药革兰氏阳性菌感染的频率正在上升，在某些情况下，这些微生物仅对糖肽类药物万古霉素和替考拉宁敏感。因此，肠球菌中出现可转移的高水平糖肽耐药性（产生了一些现在对所有可用抗生素均耐药的菌株）令人担忧。肠球菌易于在肠道定植，在医院患者中迅速传播，并在自身以及其他革兰氏阳性菌之间广泛传递抗生素耐药性。糖肽耐药性尚未在体内转移至其他重要病原体，但已在体外实现了向金黄色葡萄球菌的实验性转移。由于越来越多地使用氨基糖苷类、头孢菌素类和喹诺酮类药物治疗革兰氏阴性菌感染，以及使用糖肽类药物治疗葡萄球菌和艰难梭菌感染，导致糖肽耐药肠球菌的出现。在欧洲，动物饲料中使用糖肽类药物阿伏帕星加剧了这种抗生素压力。肠球菌现在可能随时准备在其他致病性更强的革兰氏阳性菌中传播糖肽耐药性。
