应对ESKAPE病原菌医院感染的临床药物  

CClinical drugs to combat nosocomial infections caused by ESKAPE

作　　者：万美辰 王婉蓉 马雨轩 王晨语 高鹏[2] 王忠山 焦凯 牛丽娜 WAN Mei-chen;WANG Wan-rong;MA Yu-xuan;WANG Chen-yu;GAO Peng;WANG Zhong-shan;JIAO Kai;NIU Li-na(State Key Laboratory of Military Stomatology&National Clinical Research,Center for Oral Diseases&Shaanxi Key Laboratory of Stomatology,School of Stomatology,The Fourth Military Medical University,Xi'an,Shaanxi 710000,China;不详)

机构地区：[1]军事口腔医学国家重点实验室,口腔疾病国家临床医学研究中心,陕西省口腔医学重点实验室,第四军医大学口腔医院修复科,陕西西安710049 [2]新乡医学院第三附属医院口腔科,河南新乡453003

出　　处：《中华医院感染学杂志》2020年第21期3355-3360,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81722015,81870805,81870787和81720108011);陕西省重点科技创新团队基金资助项目(2020TD-033);陕西高校青年创新团队基金资助项目。

摘　　要：屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌和肠杆菌属(Enterococcus faecium,Staphylococcus aureus,Klebsiella pneumonia,Acinetobacter baumannii,Pseudomonas aeruginosa和Enterobacter species,缩写ESKAPE)是医院感染中最常见的条件致病菌。ESKAPE病原菌感染常会伴随较高的发病率、病死率和高昂的治疗费用,其突变能力强,传播速度快,耐药情况十分严峻,成为临床抗感染治疗中的一项难题。本文综述了近5年被美国食品和药物管理局(FDA)批准用于ESKAPE病原菌感染临床治疗的药物及相关临床试验进展,其中主要包括:糖肽类抗生素、恶唑烷酮类抗生素、喹诺酮类抗生素、氨基糖苷类抗生素、四环素类抗生素。同时也讨论了两种抗菌增效剂:β-内酰胺酶抑制剂和外排泵抑制剂,其能够阻断细菌耐药机制或增强抗生素的抗菌活性。最后,对后抗生素时代应对ESKAPE病原菌进行了展望。长期以来,应对ESKAPE病原菌的医院感染是世界各国共同面临的难题,但在这场新药研发与病原菌耐药性产生的时间赛跑中,发展中国家和发达国家所处的阶段并不相同。我国作为发展中国家的代表之一,应将抗菌药物开发与我国国情相结合,以便在应对细菌耐药危机的"战役"中发挥更加积极重要的作用,提升中国的国际形象。ESKAPE pathogens(Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are referred to the most common opportunistic pathogens causing nosocomial infectionss. ESKAPE pathogen infection is often accompanied by series of intractable challenges, including the high incidence and mortality, the unaffordable expenditure of treatment, the astute mutation and infection ability of those pathogens, as well as the severe drug resistance. The clinical drugs for treatment of ESKAPE infection approved by FDA over the past 5 years and their related clinical trials were briefly discussed in the review, including glycopeptide, oxazolidinone, fluoroquinolones, aminoglycoside and tetracycline. Moreover, β-lactamase inhibitors and efflux pump inhibitors, two kinds of anti-resistance potentiators, have also been discussed in this review. They are supposed to restore antibiotics by blocking predominant bacterial resistance mechanisms or enhancing the antimicrobial action of an antibiotic. In addition, this review also provided an analytical point of the outlook about ESKAPE pathogens in the post-antibiotic era. For a long period of time, developed countries and developing countries may play different roles in this competition against antibiotic resistance. As one of the representatives of developing countries, China should take both the development of antibiotics and our national conditions into considerations so as to play a significant role in dealing with the bacterial drug resistance crisis and enhance China’s international stage.

关 键 词：医院感染 抗菌药物 抗菌增效剂 ESKAPE病原菌 

分 类 号：R978.1[医药卫生—药品]