肾脏病学中的细菌抗药性

Mounia Azizi, Souhail Mouline
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摘要

细菌对抗生素的耐药性(ABR)是对公共卫生的一大威胁,尤其是在肾脏病学领域,其影响深远,包括住院时间延长、医疗成本增加和死亡率上升。事实上,慢性肾脏病(CKD)患者是抗生素耐药菌(ARB)引起感染的高危人群,因为他们过度接触医疗设施,而且肠道微生物群的质量已经受到 CKD 的破坏。在全球范围内,这种人群的定植率和 ARB 感染率都非常高。这些 AROs 抵抗抗生素作用的机制是多方面的。这可能包括产生抗生素抑制酶(ATB)、细菌膜防水或改变抗生素靶点。它们包括耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)和几种耐多药革兰氏阴性菌。ATB的选择压力、耐药性决定因素的机构间传播、不理想的感染控制措施以及频繁的国际旅行等因素促进了这些ARB的出现和全球传播。这种名副其实的大流行病的传播凸显出迫切需要新的治疗方案、开展正确处方抗生素的宣传活动以及改进感染预防措施,尤其是在血液透析中心。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bacterial Resistance in Nephrology
Bacterial resistance to antibiotics (ABR) is a major threat to public health, particularly in nephrology, with far-reaching consequences, including longer hospital stays, higher healthcare costs and increased mortality. Indeed, patients with chronic kidney disease (CKD) are a population at risk of developing infections caused by antibiotic-resistant bacteria (ARBs), given their overexposure to healthcare facilities and the quality of their gut microbiota already damaged by CKD. It is a population with very high rates of colonization and ARB infection worldwide. The mechanisms deployed by these AROs to counteract the effect of antibiotics are multiple. This may include the production of antibiotic-inhibiting enzyme (ATB), waterproofing of the bacterial membrane, or modification of the antibiotic target. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) species, and several multidrug-resistant Gram-negative organisms. The emergence and global spread of these ARBs is facilitated by ATB selection pressure, inter-agency transmission of resistance determinants, suboptimal infection control practices, and frequency of international travel, among other factors. The spread of this veritable pandemic highlights the urgent need for new treatment options, the implementation of awareness campaigns to properly prescribe antibiotics and improve infection prevention practices, particularly at hemodialysis centers.
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