逆转细菌耐药性的影响因素综述

David

THE LANCET Infectious diseases
Volume 9, Issue 6, June 2009, Pages 357-364
Review
Factors affecting the reversal of antimicrobial-drug resistance
逆转细菌耐药性的影响因素综述
Pål J Johnsen PhDa, , , Jeffrey P Townsend PhDc, Thomas Bøhn PhDd, Gunnar S Simonsen MDb, e, f, Arnfinn Sundsfjord MDb, e and Kaare M Nielsen PhDa, d

aDepartment of Pharmacy, Faculty of Medicine, University of Tromsø, Tromsø, Norway

bDepartment of Medical Biology, Faculty of Medicine, University of Tromsø, Tromsø, Norway

cDepartment of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA

dGenØk—Centre for Biosafety, Tromsø

eDepartment of Microbiology and Infection Control, University Hospital of North Norway, Tromsø

fNorwegian Institute of Public Health, Oslo, Norway


Available online 22 May 2009.

Summary
The persistence or loss of acquired antimicrobial-drug resistance in bacterial populations previously exposed to drug-selective pressure depends on several biological processes. We review mechanisms promoting or preventing the loss of resistance, including rates of reacquisition, effects of resistance traits on bacterial fitness, linked selection, and segregational stability of resistance determinants. As a case study, we discuss the persistence of glycopeptide-resistant enterococci in Norwegian and Danish poultry farms 12 years after the ban of the animal growth promoter avoparcin. We conclude that complete eradication of antimicrobial resistance in bacterial populations following relaxed drug-selective pressures is not straightforward. Resistance determinants may persist at low, but detectable, levels for many years in the absence of the corresponding drugs.