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众所周知，美国的HAI中有三分之二是由ESKAPE这6个字母缩写的细菌引起。那么ESKAPE究竟包括了哪些细菌呢？我们看看来自IDSA的一篇文章 Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America
有关ESKAPE描述的原文：
E: E. faecium (VRE) 耐万古霉素屎肠球菌
Consistently identified as the third most frequent cause of nosocomial bloodstream infection (BSI) in the United States, enterococcal BSIs remain a significant problem [48, 49]. Vancomycin resistance likewise continues to increase, with a rate
of ∼60% among E. faecium isolates [48]. Despite growing incidence,there is a paucity of meaningful data that address efficacy of our newer agents, such as linezolid, daptomycin, and tigecycline, in the therapy of these infections, and tolerability remains problematic [50–52].
S: S. aureus (MRSA) 耐甲氧西林金黄色葡萄球菌
Despite the addition of several new agents to treat MRSA infection, clinicians are routinely faced with treatment challenges
involving patients with invasive disease. Although criteria for treating skin and skin-structure infection due to communityassociated MRSA are evolving [53], the need is great for oral agents for step-down therapy for the group of patients who require initial parenteral therapy. Because of the prominence of toxin activity in these infections, protein synthesis inhibition
may also be desirable [54, 55]. Novel classes are clearly needed for MRSA, because current drug classes exhibit treatment-limiting toxicities and emerging resistance [56–58]. Nondrug therapies, including vaccines and antibodies, are particularly attractive,because they may allow targeted preventive or adjunctive therapy for populations at particular risk, such as dialysis-dependent patients or surgical patients at high risk (e.g.,cardiac surgery). Unfortunately, studies to date have failed to demonstrate efficacy for these agents.
K: ESBL-producing E. coli and Klebsiella species 产ESBL的大肠埃希菌和克雷伯菌
Infection due to ESBL-producing E. coli and Klebsiella species continue to increase in frequency and severity. The number of enzymes and the number of organisms that exhibit cross-resistance to other classes of antimicrobials is growing, which makes selection of therapy even more challenging [4, 11, 27,59, 60].The impact of these infections was initially difficult to ascertain.However, a recent single-center study showed that BSI due to an ESBL-producing organism was an independent predictor of mortality, prolonged length of stay, delay in initiation of appropriate antimicrobial therapy, and increased hospitalization costs. In a meta-analysis of 16 studies reported for 1996–2003, ESBL-producing BSI was significantly associated with delayed initiation of effective therapy and increased crude mortality [61, 62].Despite this growing, serious problem, the molecules in latestage development, as well as the recently approved doripenem,represent only incremental advances over existing carbapenems [63].
More K: K. pneumoniae Carbapenemase-Hydrolyzing b-Lactamases 产KPC酶的大肠埃希菌、肺炎克雷伯菌及其它肠杆菌科细菌
Carbapenem-resistant Enterobacteriaceae are increasingly recognized as the cause of sporadic and outbreak infections in the United States and Europe [64–69]. Plasmid-encoded carbapenemases were initially described in K. pneumoniae and were later recognized in E. coli and other Enterobacteriaceae [64,70]. These organisms cause severe infections among residents of long-term-care facilities and are not easily detected in the clinical microbiology laboratory [71]. Little is known with regard to optimal antimicrobial therapy, and few drugs demonstrate activity. Tigecycline and the polymyxins, including colistin, have been used in individual cases with variable success [9]. Aggressive infection-control practices are required in aborting these outbreaks, and there are currently no antibacterials in advanced development for these resistant pathogens [66, 72].
A: A. baumannii 碳青酶烯类耐药药鲍曼不动杆菌
The incidence of infection due to MDR Acinetobacter species continues to increase globally [73, 74]. Recent studies of patients
in the intensive care unit who had BSI and burn infection due to carbapenem-resistant Acinetobacter species demonstrate
an increased mortality (crude mortality, 26%–68%), as well as increased morbidity and length of stay in the intensive care
unit [75].Tigecycline shows in vitro activity against gram-positive and gram-negative organisms, including MRSA, and Acinetobacter isolates. Although successful treatment of A. baumannii infection has been reported, reports of breakthrough infections have led to some caution with regard to the use of this newer agent to treat infection caused by this pathogen [74, 76–79].Tigecycline received FDA approval in 2005 for treatment of cSSSI and complicated intra-abdominal infections. Although
community-acquired pneumonia trials met primary end points,the HAP/VAP study was unsuccessful, thus leaving Tigecycline’s
role in HAP/VAP treatment unclear [27, 80].Unfortunately, as in 2006, we cannot identify candidate compounds in late-stage development for treatment of MDR Acinetobacter infection; this pathogen is emblematic of the mismatch between unmet medical needs and the current antimicrobial research and development pipeline [75].
P: P. aeruginosa 碳青酶烯类、喹诺酮类、氨基糖苷类耐药铜绿假单胞菌
Rates of infection due to resistant P. aeruginosa continue to increase in the United States and globally, as does resistance to
both the quinolones and carbapenems. Aminoglycoside resistance is emerging as a significant problem [4, 81, 82]. Recent
reports also document resistance to the polymyxins. Patients at risk include those in intensive care units, particularly if they
are ventilator dependent, and individuals with cystic fibrosis [1, 27, 60]. To date, no drugs in clinical development address the issue of carbapenem resistance or MDR or offer a less toxic alternative to the polymyxins.
E: Enterobacter Species 产ESBLs、碳青酶烯酶（包括KPC酶）和头孢菌素酶的肠杆菌属细菌
Enterobacter species cause an increasing number of health careassociated infections and are increasingly resistant to multiple antibacterials [83, 84]. Infection due to Enterobacter species,especially BSI, is associated with significant morbidity and mortality[85]. As with other members of the Enterobacteriaceae,resistance occurs via ESBLs and carbapenemases (including K. pneumoniae carbapenemase-hydrolyzing b-lactamases) and inducible chromosomal cephalosporinases [83, 86]. Other than colistin and perhaps tigecycline, few antibacterials are active against these resistant organisms, and we found no drug in latestage development for these pathogens [87, 88].
本人愚钝，觉得ESKAPE中第一个E以及S、A、P没有多大疑问，但对more K和最后一个E有些疑问，我觉得最后一个E所述的其中的产碳青酶烯酶肠杆菌属细菌应该也属于more K之中，这样就存在了重复，所以个人认为上述蓝色字体部分应该改为：(not including K. pneumoniae carbapenemase-hydrolyzing b-lactamases)，加一个not，即不包括产KPC酶的肠杆菌属细菌。不知有没有道理。微生物方面确实是菜鸟一个，请大家拍砖！
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