葡萄球菌对利奈唑胺耐药机制研究进展

Advances of research on linezolid resistances in Staphylococcus species

葡萄球菌是临床常见致病菌,可引起人体多种严重感染,其耐药性的上升给临床治疗带来严峻的挑战。利奈唑胺是继万古霉素后治疗耐药革兰阳性菌所致感染的新型抗菌药物,上市后不久临床便出现利奈唑胺耐药菌株,引起各界高度重视。持续监测全球利奈唑胺耐药菌流行动态,探索利奈唑胺耐药株的耐药机制,有利于临床制定合理的用药方案,防控耐药菌的产生及广泛传播。本文就2010—2016年有关葡萄球菌属细菌对利奈唑胺耐药的研究进行综述,分析当前国内外葡萄球菌利奈唑胺耐药形势并详细阐述其主要的耐药机制,包括靶位突变(染色体、核糖体蛋白L3和L4突变),甲基转移酶及ABC外排泵介导的耐药机制,旨在为临床合理用药,耐药菌的感染防控及耐药机制的深入研究提供参考。

Staphylococcus spp. are common pathogens that are capable of causing a large variety of severe infections, and brought not only clinicians but also the security of public health great challenges due to its dramatically increasing drug-resistance. As a relatively new and the most promising antibiotic, linezolid is currently considered as the last resort for erasing Gram-positive bacteria, especially in dealing with vancomycin-resistant ones. However, not long after linezolid made its way to the market, linezolid-resistant isolates of Staphylococcus spp. have been identified from clinical samples, alerting the world by their rapid emergence. Therefore, studies regarding mechanisms beneath the linezolid resistance and a sustained surveillance for the investigation of epidemiology have become ever more essential for both the treatment and the prevention of such bacteria. This article reviewed the incidence of linezolid- resistant Staphylococcus spp. reported during 2010-2016, followed up by comparing the situation both in China and abroad with the recent epidemiological data. In addition, the main mechanism of linezolid-resistance such as chromosomal and ribosomal （L3 and L4） mutations as well as gene cfr and optrA mediated transmissible resistance, have been illustrated in details, aiming to provide further evidences for the rational use of linezolid and to establish theoretic bases for the proper prevention of linezolid-resistant bacteria.