BETA LAKTAMAZE PROŠIRENOG SPEKTRA DELOVANJA KOD REDA ENTEROBACTERALES: KLASIFIKACIJA I GENETSKA OSNOVA REZISTENCIJE
Sažetak
Beta laktamski antibiotici su jedni od najznačajnijih i najčešće korišćenih lekova u kliničkoj praksi. Rezistencija na β-laktame može da nastane na više načina. Beta laktamaze su enzimi koji hidrolizom razlažu β-laktamski prsten i time inaktiviraju antibiotik. Do sada su otkrivene i opisane brojne vrste β-laktamaza, a njihov broj se uvećava otkrićem novih vrsta. Geni koji kodiraju sintezu β-laktamaza mogu biti na bakterijskom hromozomu ili na plazmidima. U okviru β-laktamaza, poseban značaj imaju laktamaze proširenog spektra delovanja (engl. extended-spectrum β-lactamases, ESBL). Ova grupa enzima je veoma heterogena. Termin ESBL se najčešće odnosi na β-laktamaze koje razlažu peniciline, cefalosporine i monobaktame, ali ne i cefamicine i karbapeneme i bivaju inhibirane inhibitorima beta laktamaza, klavulanskom kiselinom i/ili tazobaktamom. Među ESBL enzimima daleko najveći klinički značaj imaju CTX-M, a zatim TEM i SHV tipovi, koji su široko rasprostranjeni u celom svetu. Ostali, manje učestali, ali klinički značajni tipovi ESBL enzima uključuju VEB, PER, GES, TLE, IBC, BES, BEL i druge tipove. Poslednjih godina rezistentne bakterije se nalaze i van kliničkih okruženja, uključujući vodu, zemljište i životinje koje se koriste za ljudsku ishranu. Ukoliko se ovaj problem, koji je postao prisutan u svim sredinama, ignoriše, karbapenemi mogu da postanu prva linija prilikom empirijskog lečenja infekcija. Neophodna je edukacija koja naglašava potrebu za što manjim korišćenjem antibiotika jer se rezistentni sojevi šire velikom brzinom.
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