Methicillin抗藥性金黃色葡萄球菌之抗藥機轉

Mechanisms of Resistance in Methicillin-Resistant Staphylococcus Aureus

王志堅(Chih-Chien Wang)；朱夢麟(Mong-Ling Chu)

Methicillin抗藥性金黃色葡萄球菌:內因性抗藥性 ； 異質性 ； Methicillin-resistant Staphylococcus aureus ； Intrinsic resistance ； Heterogeneous expression

Journal of Medical Sciences

10卷6期（1990 / 12 / 01）

341 - 348

繁體中文

金黃色葡萄球菌是人類最常見致病細菌中的一種；在1940年代早期，因為盤尼西林的使用，使得金黃色葡萄球菌引起的感染得以控制，但是不久就出現了對盤尼西林產生抗藥性的菌株，並且造成全球廣泛的流行，及對生命的威脅。到了1959年，才發展出能對抗盤尼西林酶的抗生素，如methicillin，並應用到臨床上，剛開始，治療結果非常好，但是很不幸的，不到二年的時間，在1961年，就出現了methicillin抗藥性的菌株，直到今天為止，此一抗藥性菌株仍然在全世界各地造成流行，尤其是院內感染的發生，使得病人死亡率增加，醫療費用提高。而methicillin抗藥性金黃色葡萄球菌的抗藥機轉，非常特殊，尤其是異質性（heterogeneous）抗藥性的表現方式，雖然是屬是內因性（intrinsic）的抗藥機轉，但是與其他細菌產生的抗藥機轉有所不同；因此，雖然經過了將近40年的研究，目前，仍然未完全了解其抗藥機轉。本篇文章主要是綜合近年來對methicillin抗藥性金黃色葡萄球菌的研究論文，加以整理討論，並提出未來研究的可行方向。

Staphylococcus aureus is one of the most human pathogens. In the early 1940s the introduction of penicillin G temporarily solved the problem of staphylococcal infection, but the continued use of this agent caused the selection of resistant strains, staphylococcal infections remain not only common but also life threatening throughout the world. When methicillin was introduced for clinical use in 1959 it was doubtless hoped that, as the first penicillinase-resistant beta-lactam antibiotic, if at all; such hopes were shortlived. In 1961 the first report of methicillin-resistant staphylococci was published, and since then the occurrence of methicillin-resistant Staphylococcus aureus spread around the world. These strains now pose a serious problem to patients. A striking feature of methicillin resistance in Staphylococcus aureus is the considerable heterogenity of expression of resistance by cells in clonal populations. The precise mechanism of resistance to methicillin is not yet fully understood. In this article, we have reviewed many literatures about mechanisms of resistance in methicillin-resistant staphylococci. Methicillin resistance is genetically and biochemically complex, the elements involved in the heterogeneous or homogeneous expression of resistance remain to be defined.