Resistance to polymyxins: Mechanisms, frequency and treatment options

被引：192

作者：

Falagas, Matthew E. ^{[1
,2
,3
]}

Rafailidis, Petros I. ^{[1
,2
]}

Matthaiou, Dimitrios K. ^{[1
,4
]}

机构：

[1] Alfa Inst Biomed Sci, Maroussi 15123, Greece

[2] Henry Dunant Hosp, Dept Med, Athens, Greece

[3] Tufts Univ, Sch Med, Dept Med, Boston, MA 02111 USA

[4] G Gennimatas Gen Hosp, Dept Med, Thessaloniki, Greece

来源：

DRUG RESISTANCE UPDATES | 2010年 / 13卷 / 4-5期

关键词：

Colistin; Multidrug-resistance; Polymyxin; Pandrug-resistance; Fosfomycin; Tigecycline; METALLO-BETA-LACTAMASE; ANTIMICROBIAL SURVEILLANCE PROGRAM; IN-VITRO ACTIVITY; 2-COMPONENT REGULATORY SYSTEM; GRAM-NEGATIVE BACTERIA; LIPID-A MODIFICATION; INTENSIVE-CARE-UNIT; CYSTIC-FIBROSIS PATIENTS; PSEUDOMONAS-AERUGINOSA; ACINETOBACTER-BAUMANNII;

D O I：

10.1016/j.drup.2010.05.002

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

Polymyxins act by binding to lipid A moiety of the bacterial lipopolysaccharide and subsequently disintegrating the bacterial membranes. The most important mechanism of resistance includes modifications of the bacterial outer membrane structure, including lipopolysaccharide. Lipopolysaccharide modification is mostly mediated by PmrA/PmrB and PhoP/PhoQ two-component regulatory systems. These mechanisms exist with some differences in many gram-negative bacterial species. Resistance to polymyxins is generally less than 10%. In specific regions, such as the Mediterranean basin, Korea and Singapore, they tend to be higher. Heteroresistance to polymyxins is associated with exposure to polymyxins and especially suboptimal therapeutic dosage. Polymyxin combination regimens, tigecycline and fosfomycin may be useful options for the treatment of polymyxin-resistant gram-negative infections. (C) 2010 Elsevier Ltd. All rights reserved.

引用

页码：132 / 138

页数：7

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