大肠埃希菌：耐药机制及新兴治疗策略研究进展

Escherichia coli: Research Progress on Drug Resistance Mechanisms and Emerging Treatment Strategies

摘要: 自青霉素问世以来，越来越多的抗生素被发现并应用于临床，多种抗生素的选择压力催化产生了多种耐药酶，大肠埃希菌耐药性问题日益突出，给临床诊疗带来了巨大挑战。大肠埃希菌耐药机制多样，包括基因突变与修饰、抗药性基因转移、细胞膜通透性降低、灭活酶或钝化酶的产生、靶点结构改变、主动外排系统增强、生物膜形成、代谢途径适应性改变等。为应对大肠埃希菌耐药问题，新兴治疗策略一直在被研究，包括新型抗菌药物开发、新型复方制剂、噬菌体、抗菌肽、纳米技术、光动力疗法、CRISPR-Cas系统、反义疗法、粪菌移植等。本文对大肠埃希菌耐药机制进行综述，并探讨新兴治疗策略的发展现状与前景，以期为应对大肠埃希菌耐药挑战提供科学依据。

Abstract: Since the emergence of penicillin, more and more antibiotics have been discovered and applied in clinical practice. The selection pressure of multiple antibiotics has catalyzed the production of multiple resistant enzymes, and the problem of antibiotic resistance in Escherichia coli has become increasingly prominent, posing a huge challenge to clinical diagnosis and treatment. The resistance mechanisms of Escherichia coli are diverse, including gene mutations and modifications, transfer of resistance genes, decreased cell membrane permeability, production of inactivating or inactivating enzymes, changes in target structure, enhanced active efflux systems, biofilm formation, and adaptive changes in metabolic pathways. To address the issue of antibiotic resistance in Escherichia coli, emerging treatment strategies have been studied, including the development of new antibiotics, new combination formulations, bacteriophages, antimicrobial peptides, nanotechnology, photodynamic therapy, CRISPR-Cas system, antisense therapy, fecal microbiota transplantation, and more. This article provides a review of the resistance mechanisms of Escherichia coli and explores the current status and prospects of emerging treatment strategies, in order to provide scientific basis for addressing the challenges of E. coli resistance.