Antibiotic efflux is a mechanism that is well-documented in the phenotype of multidrug resistance in bacteria. Efflux is considered as an early facilitating mechanism in the bacterial adaptation face to the concentration of antibiotics at the infectious site, which is involved in the acquirement of complementary efficient mechanisms, such as enzymatic resistance or target mutation. Various efflux pumps have been described in the Gram-negative bacteria most often encountered in infectious diseases and, in healthcare-associated infections. Some are more often involved than others and expel virtually all families of antibiotics and antibacterials. Numerous studies report the contribution of these pumps in resistant strains previously identified from their phenotypes. The authors characterize the pumps involved, the facilitating antibiotics and those mainly concerned by the efflux. However, today no study describes a process for the real-time quantification of efflux in resistant clinical strains. It is currently necessary to have at hospital level a reliable and easy method to quantify the efflux in routine and contribute to a rational choice of antibiotics. This review provides a recent overview of the prevalence of the main efflux pumps observed in clinical practice and provides an idea of the prevalence of this mechanism in the multidrug resistant Gram-negative bacteria. The development of a routine diagnostic tool is now an emergency need for the proper application of current recommendations regarding a rational use of antibiotics.

中文翻译：

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革兰氏阴性菌外排耐药机制的临床现状

抗生素外排是一种在细菌多药耐药表型中得到充分证明的机制。外排被认为是细菌适应感染部位抗生素浓度的早期促进机制，这涉及获得互补的有效机制，例如酶抗性或靶点突变。在感染性疾病和医疗保健相关感染中最常遇到的革兰氏阴性菌中已经描述了各种外排泵。有些人比其他人更经常参与，并驱逐几乎所有抗生素和抗菌剂家族。许多研究报告了这些泵在先前从其表型中确定的抗性菌株中的贡献。作者描述了所涉及的泵，促进性抗生素和主要与外排有关的抗生素。然而，今天没有研究描述对耐药临床菌株的外排进行实时量化的过程。目前有必要在医院层面有一种可靠且简单的方法来量化常规外排并有助于合理选择抗生素。本综述概述了临床实践中观察到的主要外排泵的流行情况，并提供了这种机制在多重耐药革兰氏阴性菌中的流行情况。开发常规诊断工具现在是正确应用有关合理使用抗生素的当前建议的紧急需要。今天，没有研究描述对耐药临床菌株的外排进行实时量化的过程。目前有必要在医院层面有一种可靠且简单的方法来量化常规外排并有助于合理选择抗生素。本综述概述了临床实践中观察到的主要外排泵的流行情况，并提供了这种机制在多重耐药革兰氏阴性菌中的流行情况。开发常规诊断工具现在是正确应用有关合理使用抗生素的当前建议的紧急需要。今天，没有研究描述对耐药临床菌株的外排进行实时量化的过程。目前有必要在医院层面有一种可靠且简单的方法来量化常规外排并有助于合理选择抗生素。本综述概述了临床实践中观察到的主要外排泵的流行情况，并提供了这种机制在多重耐药革兰氏阴性菌中的流行情况。开发常规诊断工具现在是正确应用有关合理使用抗生素的当前建议的紧急需要。本综述概述了临床实践中观察到的主要外排泵的流行情况，并提供了这种机制在多重耐药革兰氏阴性菌中的流行情况。开发常规诊断工具现在是正确应用有关合理使用抗生素的当前建议的紧急需要。本综述概述了临床实践中观察到的主要外排泵的流行情况，并提供了这种机制在多重耐药革兰氏阴性菌中的流行情况。开发常规诊断工具现在是正确应用有关合理使用抗生素的当前建议的紧急需要。