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总之，细菌耐药机制日趋复杂，且耐药性常为多种机制并存。抗菌药物在医院、农场、社区滥用是抗菌药物耐药的主要原因。不当的抗菌药物的使用对细菌耐药产生筛选作用，使耐药菌株有更好的生存环境，导致耐药菌株的流行。因此应针对致病菌，合理选择抗菌药物、制定个体化给药方案具有重要意义。近来，循环使用抗菌药物的概念又重新活跃起来，其依据是恢复调节基因发生突变理论，有人推荐，在经验性治疗严重的全身感染时，β-内酰胺类抗生素应循环使用，即先用第三或第四代头孢菌素，然后停下来换用酶抑制剂复合制剂，再停下来换用碳青霉烯类抗生素，再回到使用第三或第四代头孢菌素，如此依次循环。美国芝加哥一所教学医院，由于医院制定了一套控制抗菌药物使用的对策，10年来，第三代头孢菌素一直保持了较高的抗菌活性，延迟了耐药性的发展。另外，需要对致病菌的耐药性进行监测，预测耐药细菌的流行情况。细菌对抗菌药物的耐药性可以是先天的或基因突变产生的，但引起耐药菌的流行主要是外源性获得耐药，如带有耐药基因的质粒或转座子在细菌之间的传递。质粒可以通过接合、转导、转化等在细菌间传播。含耐药基因的转座子带有转座酶、溶解酶及其抑制物基因，可以随机转位插入复制体或任一位置而导致细菌产生耐药性。因此，对于耐药细菌的感染，应注意严格执行消毒隔离制度，避免或减少医源性交叉感染。
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【思考题】
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1．试述常见细菌耐药机制。
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参考文献
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