碳青黴烯類抗生素抗藥性:流行病學、機轉與篩選方法

Carbapenem Resistance: Epidemiology, Mechanisms and Screening Methods

多重抗藥性為目前治療革蘭氏陰性桿菌感染之嚴重問題，過去碳青黴烯類抗生素被認為是治療多重抗藥性革蘭氏陰性菌感染有效的廣效性乙內醯胺類藥物，然而，過去十年來針對碳青黴烯類抗生素具有抗藥性之腸內菌、綠膿桿菌以及鮑氏不動桿菌成為公眾健康重要威脅。因此，準確且即時的偵測對於碳青黴烯類抗生素具有抗藥性的微生物對於病人的治療以及流行病學的監控相當重要。本篇綜論整理目前對於碳青黴烯類抗生素抗藥性的流行病學調查以及革蘭氏陰性菌抗藥性機轉，並進一步著重於目前對於碳青黴烯酶之篩選方法。

Multi-antimicrobial resistance is a major problem for treatment of Gram-negative bacterial infections. Previously, carbapenems have considered as the most effective broad-spectrum β-lactam antimicrobial agents for the defense of multidrug resistant Gram-negative organisms. However, over the last decade, carbapenem-resistance of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii have emerged as a significant public health threat. As a result, the accurate and timely detection of carbapenem-resistant organisms is crucial for appropriate patient management and for the epidemiology monitor. This review article summarizes the epidemiology of carbapenem resistance and carbapenems as major resistance mechanism in Gram-negative organisms, and also highlights recent developments of screening methods for carbapenemase production.