Abstract：
Carbapenemase-producing gram-negative bacteria (CP-GNB) infections threaten public health with high mortality, morbidity and treatment costs. Although frequencies remain low in Australia (total number of CP-GNB infections reported was 907 in 2022), blaIMP-4 has established low levels of endemicity in many states. Imipenemase metallo-β-lactamase types alone accounted for more than half of all carbapenemases in carbapenemase-producing Enterobacterales isolates in Australia, particularly in Enterobacter cloacae complex. New Delhi metallo-β-lactamase constitutes almost 25% of all carbapenemases in Australia and was identified predominantly in Escherichia coli. The OXA-48-like carbapenemases include almost 10% of all carbapenemases and are mainly seen in Klebsiella pneumoniae and E. coli. Although K. pneumoniae carbapenemase-type carbapenemases are rare in Australia, some local outbreaks have occurred. Most carbapenem-resistant (CR) Pseudomonas aeruginosa strains in Australia do not produce carbapenemases. Finally, OXA-23-like carbapenemases are overwhelmingly positive in CR-Acinetobacter baumannii strains in Australia. Treatment of CR-GNB infections challenges physicians. Of 10 new antibiotics active against at least some CR-GNB infections that are approved by the US Food and Drug Administration, just three are approved for use in Australia. In this context, there is still an unmet need for novel antibacterials that can be used for the treatment of CR-GNB infections in Australia, as well as a pressing requirement for new mechanisms to \'de-link\' antibiotic sales from their availability. In this narrative review, we aim to overview the epidemiology and clinical significance of carbapenem resistance in Australia as it pertains to Enterobacterales, P. aeruginosa and A. baumannii.
摘要：
产生碳青霉烯酶的革兰氏阴性菌（CP-GNB）感染威胁公众健康，死亡率高，发病率和治疗费用。尽管澳大利亚的频率仍然很低（2022年报告的CP-GNB感染总数为907），blaIMP-4在许多州都建立了低水平的地方性。在澳大利亚产生碳青霉烯酶的肠杆菌分离株中，单独的亚胺酶金属-β-内酰胺酶类型占所有碳青霉烯酶的一半以上，特别是阴沟肠杆菌。新德里金属-β-内酰胺酶占澳大利亚所有碳青霉烯酶的近25％，主要在大肠杆菌中被鉴定。OXA-48样碳青霉烯酶包括几乎所有碳青霉烯酶的10%,并且主要见于肺炎克雷伯菌和大肠杆菌中。尽管肺炎克雷伯菌碳青霉烯酶型碳青霉烯酶在澳大利亚很少见，一些地方爆发了。澳大利亚大多数耐碳青霉烯（CR）铜绿假单胞菌菌株不产生碳青霉烯酶。最后,OXA-23样碳青霉烯酶在澳大利亚的CR-鲍曼不动杆菌菌株中绝大多数为阳性。CR-GNB感染的治疗挑战医生。美国食品和药物管理局批准的10种新的抗生素对至少一些CR-GNB感染有效，只有三个被批准在澳大利亚使用。在这种情况下，在澳大利亚，对可用于治疗CR-GNB感染的新型抗菌药物的需求仍未满足。以及对新机制的迫切要求，将抗生素销售与其可用性“脱钩”。在这篇叙述性评论中，我们旨在概述澳大利亚碳青霉烯耐药的流行病学和临床意义，因为它与肠杆菌有关，铜绿假单胞菌和鲍曼不动杆菌。
