遏制金黄色葡萄球菌广泛耐药性以及相关转化医学平台的搭建

不断出现的耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)广泛耐药性是医疗机构和社区健康的主要威胁。社区获得性MRSA(community-acquired MRSA,CA-MRSA)是顽固的传染性致病菌,感染率和病死率高。因MRSA不但耐受所有β-内酰胺类抗生素,且具有获得外源毒力抗药基因的能力,临床治疗方法很有限。近来的研究表明CA-MRSA分离株比医院获得性MRSA更具毒力,更易传播,且具广泛耐药性,临床上只有少数几种抗生素有效(如万古霉素)。尽管已对CA-MRSA的进化机制有了一些了解,但其传播的分子过程、毒力的相关知识及治疗手段还相当有限,对医院和社区相关MRSA感染过程中的分子因素所知甚少,目前的治疗方法及抗生素的研发远落后于MRSA的进化。本文对近3年来的基础研究、成功的临床案例及细菌广泛耐药性遏制策略进行综述,以期提供关于转化医学的发展趋势和平台构建原则,从而应对包括MRSA在内的耐药致病菌。

Strategies to fight against extensive drug resistance in methicillinresistant Staphylococcus aureus and to establish an effective translational medicine system

The continuous emergence of extensive drug resistance in methicillinresistant Staphylococcus aureus （MRSA） poses a major health threat to both healthcare facilities and community settings. Communityacquired MRSA （CA-MRSA）, a persistent infectious pathogen, is a significant cause of high morbidity and mortality. Resistance to the entire class of β-lactam antibiotics, as well as acquisition of exogenous virulence genes and/or drug tolerance genes, makes MRSA infections difficult to treat in clinical practice. Recent studies suggest that CA-MRSA isolates are more virulent and transmissible than traditional hospital-acquired MRSA strains, and have extensive drug resistance, leaving only fewer efficient drugs such as vancomycin as treatment options. Al-though progress has been made towards understanding the evolutionary mechanism of CA-MRSA, our knowledge of the molecular events that underlie MRSA epidemic waves, virulence and treatment options remains incomplete. Furthermore, the molecular factors underlying the spread of hospital-and community-associated MRSA strains are still far from being completely understood, a situation calling for enhanced research efforts in that area. Additionally, the current development of effective treatment methods and new antibacterials has lagged far behind MRSA evolution. This review focuses on the biological researches, successful clinical cases, and strategies to curb increased multidrug resistance during the 3 recent years, in hope of providing perspective on future outlook for establishment of a translational medicine system to fight against resistant bacteria like MRSA.