革兰阴性菌耐药
完整摘要 · 中文译文
革兰阴性菌中抗菌药物耐药性的快速全球传播是由人类、环境和医疗保健相关因素的复杂相互作用驱动的，并因促进耐药基因传播的可移动遗传元件而加速。革兰阴性菌的耐药性主要通过药物摄入减少、药物主动外排、抗生素靶点修饰以及酶性药物灭活（最显著的是通过β-内酰胺酶的产生）而产生。临床上重要的耐药病原体包括产超广谱β-内酰胺酶的肠杆菌目细菌、耐碳青霉烯类肠杆菌目细菌、具有难治性耐药性的铜绿假单胞菌以及耐碳青霉烯类的鲍曼不动杆菌。有效抗生素的可及性有限以及现有药物耐药性的持续出现，对这些感染的管理构成了重大挑战。适当的管理需要及时准确的诊断、靶向使用新型β-内酰胺类药物、有效的感染源控制以及审慎选择治疗疗程。
完整摘要 · 英文原文
The rapid worldwide spread of antimicrobial resistance among gram-negative bacteria is driven by a complex interplay of human, environmental, and health care-associated factors and accelerated by mobile genetic elements that facilitate the dissemination of resistance genes. Resistance in gram-negative bacteria arises primarily through reduced drug entry, active drug efflux, modification of antibiotic targets, and enzymatic drug inactivation, most notably through β-lactamase production. Clinically important resistant pathogens include extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, and carbapenem-resistant Acinetobacter baumannii. Limited access to effective antibiotics and the continued emergence of resistance to available agents pose substantial challenges to the management of these infections. Appropriate management requires timely and accurate diagnostics, targeted use of newer β-lactam agents, effective source control, and judicious selection of treatment durations.