细菌抗生素耐药性:耐药机制与控制策略  

ANTIBIOTIC RESISTANCE IN BACTERIA:MECHANISMS AND CONTROL STRATEGIES

作　　者：李显志[1] 张丽[2] 

机构地区：[1]加拿大卫生部药品与食品局 [2]渥太华大学生物化学微生物学与免疫学系

出　　处：《泸州医学院学报》2011年第5期445-455,共11页Journal of Luzhou Medical College

摘　　要：细菌对抗生素的耐药性尤其是多重药物耐药性已成为全球关注的医学与社会问题,严重地威胁着感染性疾病的治疗,如常见于ESKAPE病原菌(源于肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠道杆菌属6种(类)细菌的英文缩写)的高度多重抗生素耐药性。这些细菌包括"超级细菌",因其本身基因结构的多样性和可移动性使其进化产生了多种耐药机制以对抗抗生素的作用。耐药细菌呈现的对多类不同化学结构抗生素的高度耐药性,使抗感染治疗的药物选择极其困难。耐药性基因可由细菌染色体或质粒携带,并编码介导产生抗生素灭活酶(如最近广为报道的属于金属β-内酰胺酶的NDM-1碳青霉烯酶)、改变或保护抗生素作用靶位、降低抗生素进入细菌胞内和(或)增强抗生素主动外排泵系统活性将药物排至胞外。目前研发用于临床的新型抗生素极为有限,促使重新研究优化现有抗生素。人类迫切需要同时采取多种有效措施控制抗生素耐药性,合理控制各类抗生素使用,以最大限度减少抗生素耐药性发生与传播,进而延长抗生素的有效时间,仍然是人类所面临的长期挑战。Bacterial antibiotic resistance,particularly multidrug resistance,has emerged as both medical and social problems around the globe.This constitutes a significant threat against anti-infective therapy,and the ESKAPE pathogens resistant to multiple antibiotics provide such examples.Because of their diversity of genetic structure and presence of mobile genetic elements,bacteria including those so-called＂super bugs＂have evolved various mechanisms of resistance to counter the effects of a wide variety of structurally-unrelated antibiotics and thus it is now difficult to select antibiotics for treatment of infections associated with resistant pathogens.Resistance genes carried by chromosome or plasmids encode to produce antibiotic-inactivating enzymes,alter or protect antibiotic targets,decrease the intracelluar accumulation of and/or increase the activity of antibiotic efflux pumps.Furthermore,new classes of clinically available antibiotics have been very limited,and numerous studies have aimed at optimizing the use of the existing antibiotics.All of these have demonstrated an urgent need to further take effective measures to combat antibiotic resistance.Prudent use of antibiotics or reduction of antibiotic use for minimizing the emergence and spread of antibiotic resistance and for prolonging the life-span of antibiotic drugs continue to be a long-term challenge for humans.

关 键 词：抗生素耐药性 多重耐药性 耐药机制 ESKAPE病原菌 超级细菌 感染治疗 

分 类 号：R452[医药卫生—治疗学] Q939.92[医药卫生—临床医学]