血流感染肺炎克雷伯菌耐药机制及传播机制研究

目的了解血流感染肺炎克雷伯菌的耐药机制及其耐药传播机制,为临床医院感染控制提供理论依据。方法收集南昌大学第一附属医院2012年3月至2013年9月住院患者的血液培养标本中分离获得的肺炎克雷伯菌86株,应用PCR扩增方法检测耐药基因,MLST和质粒接合试验分析其耐药传播方式。结果超广谱β-内酰胺酶基因中有26株KPC基因阳性,2株IMP基因阳性,4株VIM基因阳性,1株NDM-1基因阳性;整合子基因中有4株int基因阳性,int基因阳性的4株整合子可变区基因均为阳性;氨基糖苷类耐药基因中有22株acc6′-Ib基因阳性;喹诺酮类耐药基因中有48株qnrA基因阳性,20株qnrS基因阳性,8株qnrB基因阳性。MLST结果显示34株(39.5%)为ST395型,是主要基因型。氨基糖苷类耐药基因阳性菌株接合成功7株;喹诺酮类耐药基因阳性菌株接合成功15株。结论血流感染肺炎克雷伯菌主要以携带耐碳青霉烯酶基因和耐喹诺酮类基因为主,耐药传播机制多种,包括克隆传播和质粒介导传播。     

肺炎克雷伯杆菌对氟喹诺酮耐药的机制研究

目的研究肺炎克雷伯杆菌对氟喹诺酮类药物（FQNs）的耐药机制。方法筛选临床分离的对环丙沙星耐药的肺炎克雷伯杆菌共10株,采用微量肉汤稀释法检测菌株对5种氟喹诺酮类药物的MIC值;采用PCR方法检测菌株染色体和质粒携带的喹诺酮耐药基因（gyrA基因、parC基因和qnr基因）并测序;质粒接合试验验证qnr基因的转移性。结果 10株肺炎克雷伯杆菌对5种氟喹诺酮类药物均产生耐药性。扩增产物经测序发现10株肺炎克雷伯杆菌染色体的gyrA基因和parC基因均有突变;有2株菌株（K79和K107）携带qnrA基因,这2株菌的接合菌对喹诺酮抗菌药的MIC值上升了5～30倍;未检测到qnrB阳性的菌株。结论 gyrA和parC基因突变是肺炎克雷菌对氟喹诺酮类产生耐药机制的主要原因,质粒上qnrA基因的存在,也是产生喹诺酮耐药的一个重要因素。     

质粒介导的耐氟喹诺酮类药物基因的研究

目的 了解南昌大学第二附属医院质粒介导的耐氟喹诺酮类药物大肠埃希菌的流行情况和耐药机制.方法 收集该院2009年1月至2011年12月常规培养的耐左氧氟沙星的大肠埃希菌株100株,提取DNA后PCR扩增qnrA、qnrB、qnrC、qnrD、qnrS、aac(6’)-Ib和qepA基因,并对aac(6’)-Ib阳性产物测序比对.结果 (1)7株细菌检测出qnr基因,其中qnrA2株,qnrS 5株,1株qnrS和qnrA同时阳性,qnrB、qnrC和qnrD均未检出.(2)5株检测出aac(6’)-Ib基因,测序结果经BLAST比对均为野生型,未发现aac(6’)-Ib-cr基因.(3)所有菌株均未检测出qepA基因.结论 该院的氟喹诺酮类抗菌药的耐药机制主要还是靶位突变和细胞膜通透性改变导致的,但7％的质粒介导的耐药基因的检出率也提醒我们要密切关注质粒介导的耐药情况.     

I类整合子与产ESBLs肺炎克雷伯菌多重耐药关系的研究

目的了解产ESBLs肺炎克雷伯菌的整合子存在状况。方法用PCR方法扩增Ⅰ类整合酶基因,经电泳后检测扩增产物。结果72株产ESBLs肺炎克雷伯菌中检测出Ⅰ类整合子67株,检出率为93．0％,Ⅰ类整合子阳性菌对氨基糖苷类、喹诺酮类及头孢菌素类药物表现出较高的耐药,其多重耐药率明显高于Ⅰ类整合子阴性菌株（P〈0．05）。结论Ⅰ类整合子广泛地存在产ESBLs肺炎克雷伯菌中,Ⅰ类整合子对细菌多重耐药性的产生和传播起着重要作用。     

ICU病区大肠埃希菌中qnr基因的分布与耐药性的研究

目的调查温州医科大学附属第一医院ICU病区分离的大肠埃希菌基因的分布以及与耐药谱的关系,并初步探讨其在分子流行病学中的作用。方法收集2012年1-9月ICU病区分离的大肠埃希菌76株进行qnr基因检测,并通过DNA直接测序确定;分析qnr基因在ICU病区分离的大肠埃希菌的分布及其与耐药性的关系。结果根据PCR产物片段大小及测序分析,76株大肠埃希菌中共有qm基因阳性菌株46株,阳性率为60. 5% ;对阳性菌株进行DNA测序、BLAST比对,其中25株为qnrB基因,17株为qnrS基因阳性,12株基因阳性,未检测到qwC和qnrD基因。在46株qnr基因阳性菌株中有38株为产ESBL菌株,而在qnr阴性菌株中仅有5株ESBL阳性。结论该院ICU分离大肠埃希菌qnr基因携带严重,呈现出多重耐药性,多伴随呈现为产ESBL菌株。     

产ESBLs大肠埃希菌整合子及其相关基因盒的研究

目的检测产超广谱β-内酰胺酶（ESBLs）大肠埃希菌中整合子的整合酶及插入的相关基因盒情况,分析整合子对细菌耐药性的影响。方法采用K-B琼脂扩散法对45株临床分离的产ESBLs大肠埃希菌进行药敏试验;应用PCR法检测45株产ESBLs大肠埃希菌Ⅰ类、Ⅱ类和Ⅲ类整合子;对Ⅰ类整合子阳性菌进行整合子相关基因盒检测。结果45株菌中有27株（60．0％）含有Ⅰ类整合子,没有检测到Ⅱ类和Ⅲ类整合子阳性菌。在Ⅰ类整合子阳性菌中,有23株携带Ⅰ类整合子相关基因盒（85．2％）,5种不同的基因盒图谱,片段大小在600～2322bp,分离自同一科室的部分菌株携带大小相同的基因盒;Ⅰ类整合子阳性菌株的耐药率高于整合子阴性的菌株。结论Ⅰ类整合子及整合子相关基因盒在产ESBLs大肠埃希菌株中分布广泛,整合子在细菌耐药中发挥作用。     

痰液中产ESBL肺炎克雷伯菌Ⅰ、Ⅱ类整合子检测及基因分型研究

目的研究临床痰液分离的产ESBLs肺炎克雷伯菌Ⅰ、Ⅱ类整合子分布情况,并进行基因分型。方法分离临床痰液中100株产ESBLs的肺炎克雷伯菌,用WHONET 5.4分析菌株药敏情况,PCR检测整合酶Ⅰ、整合酶Ⅱ,ERIC-PCR进行基因分型。结果 100株菌对碳青霉烯类敏感率100%,对β-内酰胺类、氨基糖苷类、氟喹诺酮类多数耐药。整合酶Ⅰ检出率为60%,未检出整合酶Ⅱ。100株菌分为72个基因型。结论Ⅰ类整合子广泛存在于产ESBLS肺炎克雷伯菌中,与肺炎克雷伯菌的耐药相关,ERIC-PCR可用于临床分离肺炎克雷伯的基因分型。     

产ESBLs肺炎克雷伯菌Ⅰ类整合子基因盒的研究

目的探讨整合子参与产ESBLs肺炎克雷伯菌多重耐药的分子机制。方法整合酶基因扩增法检测Ⅰ类整合子;整合子可变区扩增并测序。结果8株产ESBLs肺炎克雷伯菌中有7株Ⅰ类整合子检测阳性,其中4株耐药基因盒为dfrA12-orfF—aadA2,2株为dfrA17-aadA4／aadA5,I株为aadA2,1株未检测到耐药基因盒。结论整合子介导的耐药基因盒参与了产ESBLs肺炎克雷伯菌多重耐药的形成,应引起高度重视。     

质粒介导的大肠埃希菌对喹诺酮类抗菌药物耐药机制的研究

目的了解临床分离的耐环丙沙星的大肠埃希菌质粒介导的喹诺酮类耐药基因的携带情况,并进行相关耐药机制的分析。方法采用VITEK-2全自动微生物检测系统鉴定细菌,用K-B法检测细菌对16种常用抗生素的敏感性,采用聚合酶链反应检测喹诺酮类耐药基因qnrS、qnrA、qnrB、qepA和aac（6′）-Ib,并对阳性的aac（6′）-Ib结果进行测序分析。结果 30株耐环丙沙星的大肠埃希菌中,2株（6.67%）检出qepA基因,8株（26.67%）检出aac（6′）-Ib基因,经测序证实其中6株为aac（6）′-Ib-cr（20.0%）。未检出qnrS、qnrA和qnrB基因。结论对环丙沙星耐药的大肠埃希菌携带aac（6′）-Ib-cr和qepA基因,引起质粒介导的对喹诺酮类抗菌药物的低水平耐药。     

ESBLs大肠埃希菌和肺炎克雷伯杆菌整合子分布及其与ESBLs基因关系研究

目的研究整合子在院内感染ESBLs大肠埃希菌和肺炎克雷伯杆菌中的分布及其与细菌耐药的相关性,探讨Ⅰ类整合子在ESBLs基因水平转移中的作用及其与ESBLs基因型的关系。方法运用K-B法,纸片扩散法,PCR,接合传递试验、套式PCR、质粒谱分析及DNA测序研究携带耐药基因的Ⅰ类整合子与耐药播散的关系。结果产ESBLs和非产ESBLs菌株中Ⅰ类整合酶扩增阳性例数分别是70例（占66.7%）和22例（占22.4%）,2组整合子阳性率差异有统计学意义（P〈0.01）。整合子阳性组中ESBLs、多重耐药菌均明显高于阴性组。产ESBLs菌株中blaSHV、blaCTX和blaTEM基因与整合子经质粒共同转移的频率分别是79.3%、58.5%和45.1%。结论整合子在产ESBLs大肠埃希菌和肺炎克雷伯杆菌中的分布明显高于非产ESBLs菌株,主要为Ⅰ类整合子,并参与产ESBLs菌株多重耐药性的形成,其中blaSHV基因型与整合子经质粒共同转移的频率高于其他两类基因,提示SHV型酶在浙南地区具有更强的扩散优势。     

Occurrence of qnr-positive clinical isolates in Klebsiella pneumoniae producing ESBL or AmpC-type beta-lactamase from five pediatric hospitals in China.

The plasmid-mediated quinolone resistance qnr genes in clinical isolates in adults have been described in different countries; however, the frequency of their occurrence has not been detected in pediatric patients. A total of 410 clinical isolates of Klebsiella pneumoniae, identified as producers of an extended-spectrum beta-lactamase (ESBL), or AmpC beta-lactamase, were collected from five children's hospitals in China during 2005-2006. The isolates were screened for the presence of the qnrA, qnrB, and qnrS genes, and then the harboring qnr gene isolates were detected for a bla gene coding for the TEM, SHV, CTX-M, and plasmid-mediated ampC gene by a PCR experiment. Ninety-two isolates (22.7%) were positive for the qnr gene, including 10 of qnrA (2.4%), 25 of qnrB (6.1%), and 62 of qnrS (15.1%). Eighty-one of the 92 (88.0%) qnr-positive isolates carried at least one bla gene for TEM, SHV, CTX-M, or DHA-1. The ciprofloxacin resistance increased 16-256-fold and oflaxacin resistance increased 2-32-fold in transconjugants, respectively. These results indicated that the plasmid-mediated qnr quinolone resistance gene was qnrS, followed by qnrB and qnrA. Most of the isolates also carried a bla gene coding ESBL or ampC gene coding DHA-1 among Klebsiella pneumoniae isolated from Chinese pediatric patients.     

肺炎克雷伯菌耐药性与I类整合子关系的研究

目的检测I类整合子在肺炎克雷伯菌临床分离株中的分布,分析整合子对细菌耐药性的影响。方法采用K—B纸片扩散法对127株肺炎克雷伯菌临床分离株进行药敏试验;并用WHONET5．6软件分析菌株药敏情况;采用聚合酶链反应（PCR）分析127株肺炎克雷伯菌株的I类整合子。并对I类整合子阳性株与阴性株的耐药性进行对比分析。结果127株菌中有53株（41．70％）含有I类整合子,I类整合子阳性菌株对氨基糖苷类、喹诺酮类及大多数B一内酰胺类的耐药率高于整合子阴性的菌株。结论I类整合子在肺炎克雷伯菌临床分离株存在较广,含有I类整合子的肺炎克雷伯菌更易获得耐药性。     

Coastal Seawater Bacteria Harbor a Large Reservoir of Plasmid-Mediated Quinolone Resistance Determinants in Jiaozhou Bay, China

Diversity and prevalence of plasmid-mediated quinolone resistance determinants were investigated in environmental bacteria isolated from surface seawater of Jiaozhou Bay, China. Five qnr gene alleles were identified in 34 isolates by PCR amplification, including qnrA3 gene in a Shewanella algae isolate, qnrB9 gene in a Citrobacter freundii isolate, qnrD gene in 22 Proteus vulgaris isolates, qnrS1 gene in 1 Enterobacter sp. and 4 Klebsiella spp. isolates, and qnrS2 gene in 1 Pseudomonas sp. and 4 Pseudoalteromonas sp. isolates. The qnrC, aac(6')-Ib-cr, and qepA genes could not be detected in this study. The 22 qnrD-positive Proteus vulgaris isolates could be differentiated into four genotypes based on ERIC-PCR assay. The qnrS1 and qnrD genes could be transferred to Escherichia coli J53 Azi(R) or E. coli TOP10 recipient strains using conjugation or transformation methods. Among the 34 qnr-positive isolates, 30 had a single point mutation in the QRDRs of GyrA protein (Ala67Ser, Ser83Ile, or Ser83Thr), indicating that cooperation of chromosome- and plasmid-mediated resistance contributed to the spread and evolution of quinolone resistance in this coastal bay. Eighty-five percent of the isolates were also found to be resistant to ampicillin, and bla(CMY), bla(OXY), bla(SHV), and bla(TEM) genes were detected in five isolates that also harbored the qnrB9 or qnrS1 gene. Our current study is the first identification of qnrS2 gene in Pseudoalteromonas and Pseudomonas strains, and qnrD gene in Proteus vulgaris strains. High prevalence of diverse qnr genes in Jiaozhou Bay indicates that coastal seawater may serve as an important reservoir, natural source, and dissemination vehicle of quinolone resistance determinants.     

Class 1 integrons in Pseudomonas aeruginosa isolates from clinical settings in Amazon region, Brazil

A hundred and six Pseudomonas aeruginosa isolates from clinical cases were screened using PCR for the presence of integrons and associated resistance gene cassettes. Forty-four isolates harboured class 1 integrons (41.5%), of which 29 isolates (66%) also carried gene cassettes. The aacA gene was most frequently found within class 1 integrons (69%), followed by blaOXA family genes (52%). From class 1 integron-positive strains, we detected a total of 15 isolates (34%) carrying no gene cassettes. Restriction fragment-length polymorphism analysis of the integrons variable region revealed some identical structures, as well as distinct profiles indicating heterogeneity among these cassette regions. Multiresistance was observed in 71% of isolates, nevertheless no strong correlation was observed between integron presence and multiresistance. This is the first report showing class 1 integron prevalence and gene cassette content in P. aeruginosa isolates from clinical settings in the Brazilian Amazon.     

Identification and characterization of integron-mediated antibiotic resistance among Shiga toxin-producing Escherichia coli isolates

A total of 50 isolates of Shiga toxin-producing Escherichia coli (STEC), including 29 O157:H7 and 21 non-O157 STEC strains, were analyzed for antimicrobial susceptibilities and the presence of class 1 integrons. Seventy-eight (n = 39) percent of the isolates exhibited resistance to two or more antimicrobial classes. Multiple resistance to streptomycin, sulfamethoxazole, and tetracycline was most often observed. Class 1 integrons were identified among nine STEC isolates, including serotypes O157:H7, O111:H11, O111:H8, O111:NM, O103:H2, O45:H2, O26:H11, and O5:NM. The majority of the amplified integron fragments were 1 kb in size with the exception of one E. coli O111:H8 isolate which possessed a 2-kb amplicon. DNA sequence analysis revealed that the integrons identified within the O111:H11, O111:NM, O45:H2, and O26:H11 isolates contained the aadA gene encoding resistance to streptomycin and spectinomycin. Integrons identified among the O157:H7 and O103:H2 isolates also possessed a similar aadA gene. However, DNA sequencing revealed only 86 and 88% homology, respectively. The 2-kb integron of the E. coli O111:H8 isolate contained three genes, dfrXII, aadA2, and a gene of unknown function, orfF, which were 86, 100, and 100% homologous, respectively, to previously reported gene cassettes identified in integrons found in Citrobacter freundii and Klebsiella pneumoniae. Furthermore, integrons identified among the O157:H7 and O111:NM strains were transferable via conjugation to another strain of E. coli O157:H7 and to several strains of Hafnia alvei. To our knowledge, this is the first report of integrons and antibiotic resistance gene cassettes in STEC, in particular E. coli O157:H7.     

健康猪直肠粪便中沙门菌I类整合子与耐药基因的检测

目的了解安徽省规模化猪场健康猪直肠粪便中沙门菌分离株多重耐药情况及其与I类整合子和耐药基因的携带关系。方法采用标准K-B纸片法对22株沙门菌分离株进行15种抗生素敏感试验;应用PCR技术对沙门菌分离株进行I类整合子及耐药基因检测。结果 22株沙门菌分离株中有20株(90.91%)对2种以上抗生素耐药,属于多重耐药株,羧氨苄青霉素-四环素-卡那霉素-氯霉素-氟苯尼考是主要多重耐药谱;22株沙门菌中有19株(86.4%)携带I类整合子,tetB、aph(3)-IIa和cmlA基因分别检出最高。结论沙门菌多重耐药性与整合子携带之间的关系密切,耐药表型测定结果与耐药基因检测结果基本一致,基因组DNA携带的耐药基因种类多于质粒。     

临床分离的变形杆菌中整合子分型研究

目的了解临床分离变形杆菌中1、2类整合子的流行现状及其耐药性。方法PCR扩增146株变形杆菌中1、2类整合酶基因,M-H肉汤稀释法检测146株变形杆菌的药敏情况。结果1类整合子检出率为36.9%(54/146),2类整合子检出率为38.4%(56/146),同时携带1、2类整合子的检出率为18.5%(27/146)。结论1、2类整合子在变形杆菌感染临床分离株中所占比例已相当高,1、2类整合子与变形杆菌的多重耐药具有相关性。