MECHANISMS OF ANTIMICROBIAL RESISTANCE IN CLINICALLY SIGNIFICANT BACTERIAL PATHOGENS: MOLECULAR BASIS, EPIDEMIOLOGICAL TRENDS, DETECTION METHODS, AND THERAPEUTIC COUNTERMEASURES

Antimicrobial resistance (AMR) represents one of the most urgent global public health crises of the twenty-first century, threatening to reverse a century of advances in infectious disease medicine. The World Health Organization estimates that drug-resistant infections directly caused 1.27 million deaths in 2019 and contributed to 4.95 million deaths globally, with projections suggesting AMR could claim 10 million lives annually by 2050 if current trends continue unchecked. The emergence and dissemination of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacterial pathogens—particularly the ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.)—has dramatically narrowed the available therapeutic arsenal for severe nosocomial and community-acquired infections.抗菌药物耐药性（Antimicrobial resistance, AMR）是21世纪最紧迫的全球公共卫生危机之一，或将逆转一个世纪以来传染病医学领域取得的全部进展。世界卫生组织（World Health Organization, WHO）估算，2019年耐药菌感染直接造成127万人死亡，全球范围内与耐药菌感染相关的死亡总数达495万人；若当前趋势持续得不到遏制，预计到2050年，抗菌药物耐药性每年或将造成1000万人死亡。多重耐药（multidrug-resistant, MDR）、广泛耐药（extensively drug-resistant, XDR）及全耐药（pandrug-resistant, PDR）细菌病原体——尤其是ESKAPE致病菌（屎肠球菌(Enterococcus faecium)、金黄色葡萄球菌(Staphylococcus aureus)、肺炎克雷伯菌(Klebsiella pneumoniae)、鲍曼不动杆菌(Acinetobacter baumannii)、铜绿假单胞菌(Pseudomonas aeruginosa)及肠杆菌属(Enterobacter spp.)）的出现与传播，已大幅缩减了重症医院获得性感染与社区获得性感染的可用治疗手段储备。