ABSTRACT

Introduction

Antimicrobial resistance (AR) is escalating worldwide with the potential for dire consequences, global travel contributes to the dissemination of resistant pathogens from one region to another. The World Health Organization identified the rapid emergence and prevalence of carbapenem-resistant Gram-negative species, including Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa, as an international crisis due to treatment challenges, poor health outcomes, increased mortality, and high economic costs caused by these pathogens.

Areas covered

This review describes key carbapenem-resistant (CR) Gram-negative species, changes in current global and regional trends, AR surveillance and reporting, and identifies drivers of change, specifically travel. Finally, we review clinical implications and challenges of treating CR infections which exist due to widespread dissemination of CR bacteria. A literature search was conducted using PubMed, Google Scholar, Ebsco, and ProQuest (from 2000 to December 2019).

Expert opinion

The level of global travel is increasing, and antimicrobial resistance continues to disseminate worldwide. Healthcare providers risk assessment for AR needs to consider a patient’s recent travel history, including pre-travel and intra-travel antimicrobial prescription, and potential exposure based on geography. Patient education, healthcare provider awareness, and access to data and surveillance resources are critical to inform antimicrobial selection and improve health outcomes.

中文翻译：

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全球旅行和革兰氏阴性菌耐药性；对临床管理的影响

摘要

介绍

抗微生物药物耐药性 (AR) 在全球范围内不断升级，可能带来可怕的后果，全球旅行导致耐药病原体从一个地区传播到另一个地区。世界卫生组织将耐碳青霉烯类革兰氏阴性菌（包括肠杆菌、鲍曼不动杆菌和铜绿假单胞菌）的迅速出现和流行确定为一场国际危机，原因是治疗挑战、健康结果不佳、死亡率增加和高昂的经济成本通过这些病原体。

覆盖区域

本综述描述了关键的耐碳青霉烯 (CR) 革兰氏阴性菌种、当前全球和区域趋势的变化、AR 监测和报告，并确定了变化的驱动因素，特别是旅行。最后，我们回顾了由于 CR 细菌的广泛传播而存在的治疗 CR 感染的临床意义和挑战。使用 PubMed、Google Scholar、Ebsco 和 ProQuest 进行文献检索（2000 年至 2019 年 12 月）。

专家意见

全球旅行的水平正在增加，抗菌素耐药性继续在世界范围内传播。医疗保健提供者对 AR 的风险评估需要考虑患者最近的旅行史，包括旅行前和旅行中的抗菌药物处方，以及基于地理位置的潜在暴露。患者教育、医疗保健提供者意识以及数据和监测资源的访问对于告知抗生素选择和改善健康结果至关重要。