氟化奎林酮類抗生素抗藥性的挑戰：流行病學、機轉與臨床治療上的影響

The Challenge of Fluoroquinolone Resistance: Epidemiology, Mechanisms, and Clinical Impact

多重抗藥性為目前治療細菌性感染之嚴重問題，從1980年代開始，氟化奎林酮類抗生素被廣泛用於治療革蘭氏陰性菌以及革蘭氏陽性菌的治療，然而，過去十年來針對氟化奎林酮類抗生素具有抗藥性之腸內菌、綠膿桿菌、結核分枝桿菌以及肺炎鏈球菌已經成為公眾健康重要威脅。不適當的抗生素使用為這些產生這些抗藥性菌株的主要原因，因此，準確且即時的偵測對於氟化奎林酮類抗生素具有抗藥性的菌株對於選擇有效的藥物用於治療並且減少抗藥性的產生有明顯的助益。本篇綜論整理目前對於氟化奎林酮類抗生素抗藥性的流行病學調查、病原菌的抗藥性機轉、快速偵測抗藥性機轉的方法，並進一步著重於氟化奎林酮類抗生素抗藥性對於臨床層面的影響。

Multi-antimicrobial resistance is the most pressing global concern in the treatment of bacterial infections. Fluoroquinolones (FQs) are potent, broad-spectrum agents extensively used since the 1980s to treat a wide range of Gram-positive and Gram-negative bacterial infections. However, over the last decade, FQ-resistance of Enterobacteriaceae and Pseudomonas aeruginosa, and the presence of FQ-resistant Mycobacterium tuberculosis and Streptococcus pneumonia, have emerged as a significant public health threat. The majority of these drug-resistant isolates acquired drug resistance due to improper drug use; thus, the accurate and timely identification of FQ-resistant isolates can aid in the use of more-effective treatments and reduce the occurrence of drug resistance. This review article summarizes the epidemiology of FQ resistance, resistance mechanisms in pathogens, the recent development of screening methods for FQ resistance determinants, and also highlights the clinical impact of FQ resistance.