临床常见肠杆菌科细菌对替加环素耐药机制研究进展

Progress of study on resistance mechanisms of common clinical Enterobacteriaceae against tigecycline

多耐药或碳青霉烯耐药肠杆菌科细菌(CRE)的临床分离株呈现出逐年递增趋势,给临床抗菌药物的选用提出了严峻的挑战。随着大多数临床常用抗菌药物敏感性下降,替加环素在治疗多耐药肠杆菌科细菌感染疾病中发挥了至关重要的作用,并被临床当作治疗耐碳青霉烯类肺炎克雷伯菌的最后可选抗菌药物之一。但近年来,替加环素在CRE临床分离株中逐渐表现出不同程度的耐药性,相关研究揭示其耐药机制与外排泵的各种调控途径表达上调有关,甚至相关耐药基因可能由质粒介导传播。从“同一个世界,同一个健康”的角度出发,迫切需要全面阐明替加环素的多种交互耐药机制,并精准采取措施来监测和防控其耐药性的进一步传播。

OBJECTIVE The clinical isolates of multidrug-resistant or carbapenem-resistant Enterobacteriaceae(CRE)show an increasing trend year by year,which poses a severe challenge to clinical use of antibiotics.With the decline of sensitivity to most of the commonly used antibiotics,tigecycline has played a crucial role in treatment of multidrug-resistant Enterobacteriaceae infections and has been regarded as one of the last optional antibiotics for the treatment of carbapenem-resistant Klebsiella pneumoniae.However,in recent years,the clinical isolates of CRE showed varying degree of resistance against tigecycline,and correlational studies revealed that the drug resistance mechanisms were associated with upregulated expressions of various regulatory pathways of efflux pumps,and even the related drug resistance genes might be transmitted via plasmid mediation.In terms of the perspective of"One World,One Health",it is urgent to comprehensively clarify the multiple cross resistance mechanisms of tigecycline and take precise measures to monitor and curb the further spread of its drug resistance.