Problema ustoychivosti k karbapenemnym antibiotikam: rasprostranenie karbapenemaz v mire i Rossii, epidemiologiya, diagnostika, vozmozhnosti lecheniya

This paper reviews the problem of bacterial resistance to β-lactam antibiotics, in particular to carbapenem antibiotics. The authors describe the mechanisms of antimicrobial resistance (modification of the target, reduction of the permeability of the outer structures, efflux, inactivation). It is emphasized that one of the basic mechanisms of bacterial resistance to β-lactam antibiotics is the enzymatic hydrolysis. To date, more than 1000 β-lactamases are described differing in substrate specificity, sensitivity to inhibitors and gene localization. It is a widespread beta-lactamase extended spectrum led to a sharp reduction in the clinical significance of cephalosporins III-IV generations. Carbapenems had long been the only reliable means of antibacterial therapy, but emergence of carbapenemase enzymes with genes located on mobile elements has radically changed the situation. The authors elaborate on various classes of car-bapenemases, present the data on their prevalence in Russia, describe methods of their laboratory detection and possibilities of therapy of infections caused by their producers. A strategy to slow the spread of carbapenemase producers might include testing to detect the carriage of carbapenemase producing micro-organisms, implementation of methods for identifying carbapenemase production in the routine of bacteriological laboratories, as well as measures to contain and prevent nosocomial outbreaks.

antimicrobial resistance, β-lactam antibiotics, carbapenem, β-lactamase carbapenemases