摘要

不动杆菌属是一个复杂的属，历史上一直存在多种物种存在的混淆。该物种通常会引起医院感染，主要是吸入性肺炎和导管相关性菌血症，但也会引起软组织和尿路感染。社区获得性不动杆菌感染越来越多的报道。不动杆菌的传播和随后的疾病由有机体的环境韧性，耐干燥性和逃避宿主免疫力促进。由不动杆菌属（Acinetobacter spp。）证实的毒力特性。主要源于逃避先天免疫系统的快速清除，有效实现高细菌密度，从而触发脂多糖（LPS）-Toll样受体4（TLR4）介导的败血症。荚膜多糖是使免疫逃避的关键毒力因子，而LPS引发感染性休克。然而，临床结果的主要驱动因素是抗生素耐药性。最初有效的治疗管理是提高生存率的关键，将30天的死亡率降低三倍。遗憾的是，由于该生物体具有极高的耐药性（XDR）表型，因此早期开始有效治疗是一项主要的临床挑战。鉴于其抗生素耐药率高，结果恶劣（某些病例系列中XDR菌株引起的感染死亡率高达70％），因此可以为不动杆菌属的新预防和治疗选择。

Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)–Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed.

http://cmr.asm.org/content/30/1/409.short