耐碳青霉烯类革兰阴性杆菌的耐药机制和应对策略研究进展

Research progress on drug resistance mechanism and coping strategies of carbapenem-resistant gram-negative bacilli

耐药的革兰阴性杆菌的流行播散是全球重大的公共卫生问题。对碳青霉烯类抗生素耐药的菌株,往往对其他临床常用的抗菌药物也耐药,使得临床的抗感染治疗常面临无药可用的困境,导致高额的医疗花费和较高的病死率。对耐碳青霉烯类革兰阴性杆菌的耐药机制:碳青霉烯酶的产生、孔蛋白的调节作用、药物主动外排泵的过度表达、生物膜的形成、药物作用位点的改变,以及应对策略:早期诊断并明确耐药机制、加强管控与合理用药、寻找新的抗生素及辅助药物的国内外研究进行综述,为临床防治碳青霉烯类耐药革兰阴性杆菌的感染提供参考。

The epidemic spread of drug-resistant gram-negative bacilli is a major global public health problem. Bacteria resistant to carbapenems are often resistant to other commonly used clinical antibiotics, making clinical anti-infective treatment often faced with the dilemma of no drugs available, which results in high medical costs and mortality. The drug resistance mechanisms of carbapenem-resistant Gram-negative bacilli were summarized in this review, including production of carbapenemase, regulation of porins, overexpression of active drug efflux pumps, formation of biofilm and change of drug action site. Also, domestic and foreign researches were reviewed for coping strategies as well, like early diagnosis and identification of drug resistance mechanism, strengthening control and rational drug use, and exploration of new antibiotics and adjuvant drugs. This review provided reference to the clinical prevention and treatment of carbapenem-resistant Gram-negative bacilli infection.