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首页> 美国卫生研究院文献>Open Forum Infectious Diseases >Emergent Polymyxin Resistance: End of an Era?
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Emergent Polymyxin Resistance: End of an Era?

机译：新兴的多粘菌素抗性：时代的终结？

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Until recently, the polymyxin antibiotics were used sparingly due to dose limiting toxicities. However, the lack of therapeutic alternatives for infections caused by highly resistant Gram-negative bacteria has led to the increased use of the polymyxins. Unfortunately, the world has witnessed increased rates of polymyxin resistance in the last decade, which is likely in part due to its irrational use in human and veterinary medicine. The spread of polymyxin resistance has been aided by the dissemination of the transferable polymyxin-resistance gene, mcr, in humans and the environment. The mortality of colistin-resistant bacteria (CoRB) infections varies in different reports. However, poor clinical outcome was associated with prior colistin treatment, illness severity, complications, and multidrug resistance. Detection of polymyxin resistance in the clinic is possible through multiple robust and practical tests, including broth microdilution susceptibility testing, chromogenic agar testing, and molecular biology assays. There are multiple risk factors that increase a person’s risk for infection with a polymyxin-resistant bacteria, including age, prior colistin treatment, hospitalization, and ventilator support. For patients that are determined to be infected by polymyxin-resistant bacteria, various antibiotic treatment options currently exist. The rising trend of polymyxin resistance threatens patient care and warrants effective control.
机译：直到最近，由于剂量限制毒性，仍很少使用多粘菌素抗生素。然而，由于由高抗性革兰氏阴性细菌引起的感染的治疗选择的缺乏，导致多粘菌素的使用增加。不幸的是，在过去十年中，世界目睹了多粘菌素耐药性的上升，这可能部分是由于其在人类和兽医学中的不合理使用。多粘菌素抗性的传播已通过在人类和环境中传播可转移的多粘菌素抗性基因mcr得到了帮助。抵抗大肠菌素的细菌（CoRB）感染的死亡率在不同的报道中有所不同。但是，不良的临床预后与以前的大肠菌素治疗，疾病严重程度，并发症和多药耐药性有关。通过多种强大而实用的测试，包括肉汤微稀释敏感性测试，生色琼脂测试和分子生物学测定，可以在临床上检测多粘菌素耐药性。有多种危险因素会增加一个人感染多粘菌抗性细菌的风险，包括年龄，以前的粘菌素治疗，住院和呼吸机支持。对于确定被多粘菌抗性细菌感染的患者，目前存在多种抗生素治疗选择。多粘菌素耐药性的上升趋势威胁着患者的护理并需要有效的控制。

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