艰难梭菌(Clostridium difficile)是医疗保健相关性腹泻最主要的病原菌.2002年起欧美地区艰难梭菌感染发病率和病死率均明显增高,耐药艰难梭菌的出现和传播更给临床治疗和预防带来了挑战.绝大多数临床分离菌对甲硝唑及万古霉素仍呈高度敏感,但已有异质性耐药或最低抑菌浓度上升的报道;对红霉素和莫西沙星等其他抗菌药物的耐药率在不同国家和地区则有较大差异.艰难梭菌对甲硝唑或万古霉素敏感性下降产生的耐药机制尚不明确,而对红霉素、氟喹诺酮类、四环素和利福霉素形成的耐药机制主要是因为作用靶点发生了改变.文章简述了近年来国际上艰难梭菌耐药性及耐药机制方面的研究进展.%Clostridium difficile is the leading cause of healthcare-associated diarrhea. Since 2002, the morbidity and mortality rates ofC. difficile infection have increased dramatically in Europe and North America. The emergence ofC. difficile strains that are resistant to multiple antimicrobial agents can complicate prevention programs and po-tential treatment. Although most clinical isolates are still susceptible to metronidazole and vancomycin, heteroresis-tance to metronidazole and increasing vancomycin MICs (minimum inhibitory concentrations) have been reported. The prevalence of resistance to other antimicrobial agents, including erythromycin and moxifloxacin, is highly varia-ble in different countries and regions. The exact mechanism of reduced susceptibility to metronidazole or vancomycin is still not clear. The principal mechanism of erythromycin, fluoroquinolones and rifamycins resistance inC. difficile is determined by target alterations. This review will focus primarily on the antimicrobial susceptibility patterns and resistance mechanisms ofC. difficile in order to provide an up-to-date review on the topic.
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