多重耐药菌的发展趋势

The development trend of multidrug-resistant organisms

多重耐药菌感染呈现增长趋势，已成为全球性棘手问题，抗菌药物选择方案很少。传统糖肽类药物抗菌活性已呈现下降趋势。虽然新的抗菌药物包括利奈唑胺、达托霉素和替加环素对某些革兰阳性菌感染有较强的抗菌活性，但对于多重耐药革兰阴性菌，包括耐碳青霉烯类铜绿假单胞菌、鲍曼不动杆菌和肠杆菌的治疗，有效药物仅限于多黏菌素和替加环素。多重耐药菌的分布呈动态变化，近年来，多数医疗机构特别是重症监护病房监测的菌株中，以革兰阴性细菌为主，部分地区多重耐药／泛耐药铜绿假单胞菌、鲍曼不动杆菌等呈现迅速增多趋势。应重视和执行多重耐药菌感染的监测、预防、隔离和抗菌药物选择等综合防控策略，以减少多重耐药菌的扩散。

Multidrug-resistant organisms are growing worldwide public health problem and few ther- apeutic options remain available. The traditional antimicrobials （glycopeptides） for multidrug-resistant Gram- positive infections are declining in efficacy. New antimicrobials that are presently available are linezolid, dap- tomicin and tigecycline, which have well-defined indications for severe multidrug-resistant organisms infec- tions. Unfortunately, the therapies available for multidrug-resistant Gram-negatives including carbapenem-re- sistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae are limited to colistin and tigecycline only. Distribution of multidrug-resistant organisms are changing in recent years. Strains of multi- drug-resistant organisms were dominated by Gram-negative bacteria in most hospital particularly in intensive care unit. Multidrug-resistant/pandrug-resistant Pseudomonas aeruginosa, Acinetobacter baumannii are in- creasing rapidly in trend. Strategy that includes surveillance, infection control procedures, isolation and antimi- crobial principle should be emphasized and implemented to reduce multidrug-resistant organism diffusion.