克雷伯氏菌属(Klebsiella)细菌比较基因组学分析揭示多复制子抗性质粒介导广泛的抗性基因传播

[目的] 研究克雷伯氏菌与多复制子抗性质粒间的关系,分析细菌携带多复制子质粒对抗生素环境的响应机制。[方法] 以2018-2020年分离的56株不同来源克雷伯氏菌（Klebsiella sp.）分离株为研究对象,利用微量肉汤稀释法评估其多重耐药表型,对分离菌株进行全基因组测序（WGS）,通过细菌全基因组关联分析（BGWAS）技术和比较基因组学方法深入解析多复制子抗性质粒形成的机制。[结果] 耐药表型分析发现野生动物来源的菌株具有更广的耐药谱系,总体Klebsiella sp.对氨苄西林表现出很高的耐药率（80.36%）,尤其是马来穿山甲来源菌株对头孢类抗生素高度耐受,同时对氯霉素、左氧氟沙星和复方新诺明等药物耐受,基因组分析发现这些菌株携带了抗性质粒和更多的抗生素抗性基因。进一步对69个质粒序列分析,发现有28个质粒为多复制子质粒,主要携带bla_CTX-M-15、bla_CTX-M-14、bla_CTX-M-55、bla_OXA-1和bla_TEM-1等β-内酰胺酶基因。细菌携带质粒类型分析认为Klebsiella pneumoniae可能是多复制子质粒的重要宿主,质粒骨架与结构分析发现多复制子质粒多由2个或2个以上单个质粒融合而成,携带此类质粒的菌株不仅获得了更广的耐药表型,而且在全球传播扩散分布逐年增加,因此产生对抗生素环境更强的适应性。[结论] 多重耐药性细菌呈现的表型与携带的多复制子质粒有关,相比较下多复制子质粒比非多复制子质粒有更强的抗性基因携带能力,或许是细菌在强大的抗生素压力下产生的重要响应机制。本研究对于未来探索细菌抗性基因的传播扩散机制具有重要意义。     

2017–2019年中国南方五省规模化养猪场副猪格拉菌血清型、耐药性及β-内酰胺类耐药基因bla-TEM分子特征分析

【目的】旨在分析当前规模化养殖场副猪格拉菌(Glaesserella parasuis)优势血清型、耐药特性、耐药基因与分子特征。【方法】对源自规模化养猪场21株副猪格拉菌临床分离株,采用PCR鉴定血清型;利用K-B纸片扩散法鉴定其对25种抗生素的耐药表型;采用PCR检测bla-_TEM、bla-_NDM和bla-_CTX等7种耐药基因,并采用Chi-square test和Fisher exact test分析耐药表型和耐药基因型的相关性;耐药基因目的条带测序,并应用CLC Sequence Viewer软件分析β-内酰胺类耐药基因(bla-_TEM)编码蛋白氨基酸关键位点差异与耐药性的关系。【结果】21株副猪格拉菌临床分离株的优势血清型为4和12型;对β-内酰胺类药物苯唑西林的耐药性较强,耐药菌占比达61.9%(13/21);多重耐药菌株占比高达90.5%(19/21);β-内酰胺类耐药基因bla-_TEM携带率较高(52.4%,11/21),且bla-_TEM与β-内酰胺类药物青霉素G、苯唑西林和头孢拉定的耐药性显著相关,部分bla-_TEM编码氨基酸存在可能与副猪格拉菌耐药能力有关的差异位点。【结论】本研究表明,规模化养猪场的副猪格拉菌多重耐药情况仍很严重,并明确了被调查区域β-内酰胺类药物耐药率高的主要原因是携带耐药基因bla-_TEM,为加强对规模化养猪场副猪格拉菌耐药性监测提供理论依据。     

云南地区鸭源沙门菌的分离鉴定及耐药性和毒力基因分析

【背景】沙门菌是一种重要的食源性人兽共患病原菌,可引起多种食源性疾病。【目的】了解云南地区鸭源沙门菌病的流行现状、耐药现象及毒力基因携带等基本情况。【方法】无菌采集云南各地区病死鸭肝脏样品169份进行沙门菌分离,对分离株进行血清分型鉴定、药敏及相关耐药基因、毒力基因筛查。【结果】分离到鸭源沙门菌48株,分离率为28.40%,鉴定出3种血清型,其中肠炎沙门菌为优势血清型。分离株对青霉素G、林可霉素、克林霉素和利福平的耐药率达100%,每株菌至少对3类6种及以上的抗生素耐药,单株最高可耐14种,产生了22种耐药谱型。共检出耐药基因5种,bla_TEM和tetB检出率分别为27.08%和22.92%,tetA、sul2和EBC的检出率较低。毒力基因共检出10种,其中,SPI-1(avrA)、SPI-3(mgtC)、SPI-4(siiD)、SPI-5(sopB)和bcfC检出率均高达100%,SPI-2(ssaQ)、spvB、spvC、pefA和stn的检出率均达60%以上,cdtB未检出。【结论】云南地区鸭源沙门菌主要流行血清型为肠炎沙门菌,耐药性及多重耐药情况严重,耐药机制复杂,耐药基因与耐药表型符合率低,毒力基因检出率较高。研究结果可为云南地区鸭群沙门菌病的防控和净化提供参考。     

通辽地区犊牛腹泻大肠杆菌耐药性检测及一株多重耐药菌全基因组测序分析

【背景】大肠杆菌(Escherichia coli)是引起犊牛腹泻的最主要病原菌,其耐药性菌株的不断出现引起广泛关注。【目的】了解内蒙古自治区通辽市犊牛腹泻大肠杆菌耐药性及耐药基因流行情况。【方法】从通辽市多个旗县采集犊牛腹泻样品40份,经细菌分离纯化及16S rRNA基因测序,最终鉴定出20株大肠杆菌。采用药敏试验和PCR方法对分离菌进行耐药性及耐药基因检测分析,并对其中1株多重耐药菌株进行全基因组测序。【结果】20株分离菌均具有多重耐药性,对链霉素、环丙沙星、恩诺沙星和复方新诺明的耐药率达80%以上。所检耐药基因中,aphA1、strB、TEM-1和qnrS检出率达100%。通过对代表性菌株TL-13全基因组测序发现,其基因组大小为4897185bp,GC含量为50.68%,同时携带2个质粒,大小分别为108288bp(pTL13-1)和64018bp(pTL13-2)。质粒中共携带18个可移动耐药基因。【结论】通辽地区犊牛腹泻大肠杆菌多重耐药性普遍存在,4种常见耐药基因普遍流行。     

基于双重芯片式数字PCR快速鉴定KPC型碳青霉烯耐药肺炎克雷伯菌的方法

【背景】由于碳青霉烯类药物的泛用和滥用,致使肺炎克雷伯菌碳青霉烯耐药株与日俱增,产碳青霉烯酶是肺炎克雷伯菌对碳青霉烯类药物耐药的主要原因。目前对肺炎克雷伯菌碳青霉烯耐药株的检测方法存在费时费力、特异性差、灵敏度低等问题。【目的】建立一种能同时检测肺炎克雷伯菌和碳青霉烯酶基因bla_KPC的双重芯片式数字PCR方法。【方法】依据肺炎克雷伯菌的特有基因yhaI和碳青霉烯耐药基因bla_KPC保守序列设计特异性引物和探针,确定双重芯片式数字PCR同时对yhaI和bla_KPC两个基因核酸浓度绝对定量的检测范围、检出限和最佳实验体系,并进行方法特异性、灵敏度、重复性分析及临床菌株的检测。【结果】双重芯片式数字PCR检测灵敏度比双重实时荧光定量PCR提高了约1.5个数量级,在两基因同时检出的情况下,最低检出限分别为3.74 copies/μL (yhaI基因)和1.93 copies/μL (bla_KPC基因);优化后的双重芯片式数字PCR对参考菌株检测特异性的结果与双重实时荧光定量PCR结果一致;利用优化后的双重芯片式数字PCR方法共检测58株临床菌株,其中肺炎克雷伯菌43株,属肺炎克雷伯菌且含有bla_KPC基因的菌株13株,这与质谱及耐药谱检测结果一致。【结论】利用双重芯片式数字PCR技术建立了产KPC型碳青霉烯酶肺炎克雷伯菌的绝对定量检测方法。该方法特异性强、灵敏度高、准确度好,可用于检测具有碳青霉烯酶基因bla_KPC的肺炎克雷伯菌的核酸检测和定量分析,也为产其他类型碳青霉烯酶的病原菌检测提供了新的技术参考。     

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。     

斑节对虾(非洲群体)肠道细菌抗生素耐药性及耐药基因分布特征

[目的]解析斑节对虾(Penaeus monodon)(非洲群体) (俗称"金刚虾",以下同)携带耐药菌及耐药基因现状。[方法]本研究从山东滨州北海新区采集了金刚虾,对其肠道细菌常用抗生素的耐药菌性质及数量、占比及种类进行检测,通过荧光定量PCR技术分析肠道内容物样品中的4类抗生素的4种耐药性基因分布特征。[结果]肠道中可培养细菌总数约1.45×10⁵- 2.13×10⁶CFU/g,有四环素、萘啶酸、氟苯尼考、庆大霉素4种抗生素耐药菌的检出,其中喹诺酮类萘啶酸耐药菌占比最高,达到35.00%,氨基糖苷类庆大霉素占比最少。10种抗生素药敏性质分析表明,肠道可培养细菌对庆大霉素、氟苯尼考等6种抗生素高度敏感,对四环素、卡那霉素中度敏感,对萘啶酸、青霉素、阿莫西林耐药。从分离的耐药菌鉴定结果可以得出,可培养的抗生素耐药菌主要集中在弧菌属,基于属水平的不同抗生素耐药菌统计显示,不同抗生素耐药菌种类存在明显差异,且同一菌属有耐多种抗生素的情况。荧光定量PCR检测分析,4种耐药基因的丰度不同,tetA基因相对拷贝数和四环素耐药菌比例、floR基因和氟苯尼考耐药菌比例之间存在显著相关性(P<0.01);qnrA基因相对拷贝数和萘啶酮酸耐药菌比例、aadA基因相对拷贝数和庆大霉素耐药菌比例之间均不存在显著相关性(P>0.01)。[结论]本研究说明,金刚虾肠道微生物中存在一定的耐药菌和耐药基因,具有携带风险。     

苯唑西林敏感、mecA基因阳性的猪源金黄色葡萄球菌的流行、分子分型及耐药性研究

[目的] 为了解我国猪源苯唑西林敏感-mecA阳性金黄色葡萄球菌（Oxacillin-susceptible,mecA-positive Staphylococcus aureus,OS-MRSA）的流行情况、菌株分子特征及耐药性,本研究对我国中西部4个省份（甘肃、陕西、河南和广西）的9个规模化养猪场进行鼻腔拭子样本采集。[方法] 运用PCR扩增nuc和mecA基因及苯唑西林耐药性检测对OS-MRSA菌株进行分离鉴定。然后对分离所得的OS-MRSA菌株进行26种毒素编码基因、16种抗生素耐药性以及spa、MLST和SCCmec分型检测。[结果] 结果表明,采集的884份样本中,67份样本7.6%（67/884）分离到金黄色葡萄球菌,包括50株甲氧西林敏感菌株（Methicillin-sensitive Staphylococcus aureus,MSSA）、8株苯唑西林耐受-mecA阳性金黄色葡萄球菌（Oxacillin-resistant mecA-positive,OR-MRSA）和9株OS-MRSA菌株。26种被检毒素编码基因中有9种毒素编码基因被检出,其中hla基因检出率最高,其次为hld、hlb、hlg、sei、sem、seg、sen和seo。此外,67株分离株中仅有16株携带肠毒素编码基因,其中OR-MRSA和OS-MRSA菌株分别占37.5%（6/16）和50.0%（8/16）,且携带毒素编码基因的菌株克隆型均为ST9-t899。16种所测试抗生素中,菌株对12种抗生素表现为耐药,其中MSSA、OR-MRSA和OS-MRSA分离株分别主要对1-8、10-12和7-11种抗生素耐药。所有分离株共有4种克隆型ST398-t571、ST9-t899、ST398-t034和t11241,其中ST9-t899为MRSA菌株唯一克隆型和ST398-t571为MSSA优势克隆型。除4株分离株未检测到SCCmec分型外,IV_b（76.5%,13/17）是MRSA分离株的唯一分型。[结论] 结果表明,我国猪源MRSA分离株对苯唑西林药物敏感性发生了改变,出现了较多的苯唑西林敏感菌株。此外,MSSA和MRSA分离株优势克隆型分别为ST398-t571和ST9-IVb-t899。研究还发现,克隆型与毒素编码基因有显著相关性,携带毒素编码基因的菌株克隆型均为ST9-t899。通过了解我国猪源MSSA、OR-MRSA和OS-MRSA的流行、分子特征和耐药性,可以为我国猪源金黄色葡萄球菌的防控提供数据支持。     

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。     

五株克雷伯氏菌噬菌体的生物学特性及比较基因组学研究

【目的】耐药性克雷伯氏菌属(Klebsiella)的细菌作为人类感染的重要病原,是临床治疗重要的挑战。本研究对多株克雷伯氏菌裂解性噬菌体的生物学特性和基因组特征进行比较分析,为其应用提供更多科学数据。【方法】使用双层平板法从人类和动物新鲜粪便、污水中分离纯化裂解性克雷伯氏菌噬菌体;通过磷钨酸染色和透射电镜观察其形态;采用双层平板噬菌斑法确定其宿主范围,测定温度和pH稳定性、一步生长曲线和体外抑菌效果等生物学特性;基于全基因组测序对分离株进行比较基因组学分析;通过体内抑菌试验评估噬菌体对多重耐药变栖克雷伯氏菌(Klebsiella variicola) BS375-3感染的大蜡螟(Galleria mellonella)幼虫的保护作用。【结果】5株噬菌体分别属于Schitoviridae (pKP-BM327-1.2)、Autographiviridae (pKP-M186-2.1、pKP-M186-2.2和pKV-BS375-3.1)、Drexlerviridae (pKP-BS317-1.1)家族;噬菌体pKV-BS375-3.1可裂解受试菌中的8株,pKP-BM327-1.2可裂解受试菌中的3株,pKP-M186-2.1、pKP-M186-2.2和pKP-BS317-1.1则分别裂解受试菌中的1株;5株噬菌体感染10-20 min后即进入指数增长期,在-20-37 ℃、pH 6-10环境下均能够保持稳定活性;感染变栖克雷伯氏菌BS375-3后经噬菌体pKV-BS375-3.1处理[感染复数(multiplicity of infection, MOI)=100]的大蜡螟幼虫96 h内存活率达到80% (8/10);5株噬菌体基因组长度在42-77 kb之间,未携带抗生素抗性基因和毒力基因,基于内溶素(endolysin)的溯源分析显示该蛋白在克雷伯氏菌噬菌体中呈现多样性,属内呈保守性。【结论】5株克雷伯氏菌噬菌体均具有较好的体外抑菌活性,生物学特性稳定,endolysin在噬菌体属内呈现保守性。宿主谱宽、潜伏期短的噬菌体pKV-BS375-3.1在治疗Klebsiella pneumoniae和K. variicola临床感染方面具有潜在应用前景。     

Co-occurrence of genes encoding carbapenemase,ESBL, pAmpC and non-β-Lactam resistance among Klebsiella pneumonia and E. coli clinical isolates in Tunisia

This study aimed to investigate the molecular mechanisms of carbapenem and colistin resistance in K. pneumoniae and E. coli isolates obtained from hospitalized patients in Carthagene International Hospital of Tunis. A total of 25 K. pneumoniae and 2 E. coli clinical isolates with reduced susceptibility to carbapenems were recovered. Susceptibility testing and phenotypic screening tests were carried out. ESBL, AmpC, carbapenemase and other antibiotic resistance genes were sought by PCR-sequencing. The presence of plasmid-mediated colistin resistance genes (mcr-1-8) was examined by PCR and the nucleotide sequence of the mgrB gene was determined. The analysis of plasmid content was performed by PCR-Based Replicon Typing (PBRT). The clonality of isolates was assessed by PFGE and multilocus sequence typing (MLST). All of the isolates produced carbapenemase activity. They showed a great variation in the distribution of ESBL, AmpC, carbapenemase and other plasmid-mediated resistance determinants. K. pneumoniae isolates carried bla_NDM-1 (n = 11), bla_OXA-48 (n = 11), bla_NDM-1 + bla_OXA-48 (n = 1), bla_NDM-1 + bla_VIM-1 (n = 1), bla_OXA-204 (n = 1), along with bla_CTX-M, bla_OXA, bla_TEM, bla_CMY, bla_DHA and bla_SHV genes variants on conjugative plasmid of IncL/M, IncR, IncFII_K, IncFIB, and IncHI1 types. Three sequence types ST101, ST307 and ST15 were identified. The mgrB alteration g109a (G37S) was detected in a single colistin-resistant, NDM-1 and OXA-48-coproducing K. pneumoniae isolate. The two E. coli isolates belonged to ST95, co-produced NDM-1 and CTX-M-15, and harboured plasmid of IncFII and IncFIB types. To our knowledge, this is the first report in Tunisia of NDM-1, OXA-48, and CTX-M-15 coexistence in colistin-resistant K. pneumoniae ST15.     

Differentiation of IncL and IncM Plasmids Associated with the Spread of Clinically Relevant Antimicrobial Resistance

Introductionbla_OXA-48, bla_NDM-1 and bla_CTX-M-3 are clinically relevant resistance genes, frequently associated with the broad-host range plasmids of the IncL/M group. The L and M plasmids belong to two compatible groups, which were incorrectly classified together by molecular methods. In order to understand their evolution, we fully sequenced four IncL/M plasmids, including the reference plasmids R471 and R69, the recently described bla_OXA-48-carrying plasmid pKPN-El.Nr7 from a Klebsiella pneumoniae isolated in Bern (Switzerland), and the bla_SHV-5 carrying plasmid p202c from a Salmonella enterica from Tirana (Albania).MethodsSequencing was performed using 454 Junior Genome Sequencer (Roche). Annotation was performed using Sequin and Artemis software. Plasmid sequences were compared with 13 fully sequenced plasmids belonging to the IncL/M group available in GenBank.ResultsComparative analysis of plasmid genomes revealed two distinct genetic lineages, each containing one of the R471 (IncL) and R69 (IncM) reference plasmids. Conjugation experiments demonstrated that plasmids representative of the IncL and IncM groups were compatible with each other. The IncL group is constituted by the bla_OXA-48-carrying plasmids and R471. The IncM group contains two sub-types of plasmids named IncM1 and IncM2 that are each incompatible.ConclusionThis work re-defines the structure of the IncL and IncM families and ascribes a definitive designation to the fully sequenced IncL/M plasmids available in GenBank.     

污水厂产超广谱β内酰胺酶大肠杆菌通过接合水平传递耐药性

【目的】研究废水中产超广谱β-内酰胺酶大肠杆菌中可移动质粒在耐药基因水平传播机制中的作用。【方法】对污水厂分离所得的50株产ESBLs大肠杆菌进行接合试验,并对所得的接合子采用纸片扩散法测定其对15种常见药物的耐药表型,针对质粒介导的产ESBLs菌株的耐药基因设计7对特异性引物对接合子进行PCR扩增。【结果】研究结果显示,80份水样分离得50株产ESBLs大肠杆菌,共接合成功35株细菌,接合成功率高达70%。接合子与供体菌相比,均发生耐药谱型的改变,且存在丢失一种或几种药物耐药性且产生另一种或几种药物耐药性的现象。PCR扩增结果显示,接合子与供体菌相比,耐药基因型有所减少或不变,bla_(TEM)、bla_(CTX-M)基因全部接合成功,bla_(SHV)基因仅1株未接合成功,耐氟喹诺酮类基因未发生转移。【结论】本研究表明,不同的耐药基因可能位于不同的可移动质粒上,可移动质粒在大肠杆菌耐药性水平传播的过程中起到了十分重要的作用。     

Prevalence of the <Emphasis Type="Italic">bla</Emphasis><Subscript>SHV</Subscript> Gene in <Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis> Isolates Obtained from Hospital and Community Infections and from the Microbiota of Healthy Individuals in Recife,Brazil

The aim of this study was to determine the prevalence of the bla _SHV gene in Klebsiella pneumoniae isolates from hospital and community infections and from the normal microbiota of healthy individuals in Recife, PE, Brazil. Fifty-two K. pneumoniae isolates were analyzed regarding the presence of the bla _SHV gene, using PCR, and eight isolates were analyzed by DNA sequencing. This gene was detected in 16 isolates from hospital infections, four from community infections, and nine from the normal microbiota. This was the first study to find the bla _SHV gene in K. pneumoniae isolates from the normal microbiota. Through DNA sequencing of eight K. pneumoniae isolates from hospital and community infections, with a resistance phenotype indicative of extended-spectrum β-lactamase production, a new SHV variant named SHV-122 was found. We also detected the presence of bla _SHV-1, bla _SHV-11, bla _SHV-28, and bla _SHV-108. The results show that in Recife, Brazil, K. pneumoniae isolates that presented resistance to oxyimino-β-lactams had high prevalence and diversity of the bla _SHV gene. We also conclude that there was a high presence of the bla _SHV gene among isolates from the normal microbiota of healthy individuals.     

市售畜禽肉产CTX-M酶大肠杆菌的流行病学调查

【目的】调查市售畜禽肉类中大肠杆菌的耐药状况和blaCTX-M基因的流行病学特征。【方法】采集广州市不同区域零售市场和超市畜禽肉类样品进行大肠杆菌的分离,通过基因phoA扩增和测序进行大肠杆菌鉴定,采用琼脂扩散法和微量肉汤稀释法测定药物敏感性,通过PCR扩增检测blaCTX-M基因,对blaCTX-M阳性大肠杆菌进行全基因组测序。【结果】从323份市售畜禽肉样品中分离获得大肠杆菌241株;药物敏感性结果表明大肠杆菌对氨苄西林(63.07%)、多西环素(47.72%)和复方新诺明(43.15%)耐药率较高;blaCTX-M基因检出率为3.32%(n=8),其中4株携带blaCTX-M-14,3株携带blaCTX-M-65,1株携带blaCTX-M-55;8株产CTX-M大肠杆菌可分为4种不同的ST型,且携带多种耐药基因和毒力基因。【结论】市售畜禽肉中大肠杆菌污染严重。产CTX-M酶大肠杆菌均为多重耐药菌株,且blaCTX-M基因主要以水平传播方式在大肠杆菌中传播,需要加强监测。     

Characteristics of plasmids in multi-drug-resistant Enterobacteriaceae isolated during prospective surveillance of a newly opened hospital in Iraq

Background

Gram-negative multidrug-resistant (MDR) bacteria are major causes of nosocomial infections, and antibiotic resistance in these organisms is often plasmid mediated. Data are scarce pertaining to molecular mechanisms of antibiotic resistance in resource constrained areas such as Iraq.

Methodology/Principal Findings

In this study, all MDR Enterobacteriaceae (n = 38) and randomly selected non-MDR counterparts (n = 41) isolated from patients, healthcare workers and environmental surfaces in a newly opened hospital in Iraq were investigated to characterize plasmids found in these isolates and determine their contribution to antibiotic resistance. Our results demonstrated that MDR E. coli and K. pneumoniae isolates harbored significantly more (≥3) plasmids compared to their non-MDR counterparts, which carried ≤2 plasmids (p<0.01). Various large plasmids (∼52 to 100 kb) from representative isolates were confirmed to contain multiple resistance genes by DNA microarray analysis. Aminoglycoside (acc, aadA, aph, strA/B, and ksgA), β-lactam (bla _TEM1, bla _AMPC, bla _CTX-M-15, bla _OXA-1, bla _VIM-2 and bla _SHV), sulfamethoxazole/trimethoprim (sul/dfr), tetracycline (tet) and chloramphenicol (cat) resistance genes were detected on these plasmids. Additionally, multiple plasmids carrying multiple antibiotic resistance genes were found in the same host strain. Genetic transfer-associated genes were identified on the plasmids from both MDR and non-MDR isolates. Seven plasmid replicon types (FII, FIA, FIB, B/O, K, I1 and N) were detected in the isolates, while globally disseminated IncA/C and IncHI1 plasmids were not detected in these isolates.

Conclusions/Significance

This is the first report of the characteristics of the plasmids found in Enterobacteriaceae isolated following the opening of a new hospital in Iraq. The information provided here furthers our understanding of the mechanisms of drug resistance in this specific region and their evolutionary relationship with other parts of world. The large plasmids, carrying resistance genes and transfer-associated genes, may be potential factors for regional dissemination of antibiotic resistance.     

广州南沙湿地公园候鸟源肠杆菌科耐药性及产超广谱β-内酰胺酶基因监测调查

[背景]耐药基因可通过水平转移在环境、动物和人体间发生转移,而远距离传播则主要通过候鸟的迁徙。耐药基因可通过水平转移和候鸟迁徙跨地区传播至禽畜和人类,引起公共卫生问题。[目的]分离广州南沙湿地公园候鸟粪便中肠杆菌科细菌,并鉴定菌种类别,研究其对常见抗生素的耐药性及携带的主要超广谱β-内酰胺酶(extended-spectrum beta-lactamase,ESBL)耐药基因,评估广州南沙湿地公园候鸟储存、携带耐药菌和耐药基因的风险。[方法]2019年1月-12月,采集广州南沙湿地公园候鸟粪便样本393份,并进行细菌分离、培养和鉴定。使用药敏检测板对细菌进行耐药性检测。PCR扩增待测细菌的blaCTX-M、blaTEM和blaSHV耐药基因,测序并进行BLAST比对。[结果]检出肠杆菌科细菌59株(检出率为15.01%),主要优势菌为成团泛菌(36株,占肠杆菌科细菌61.02%)。肠杆菌科细菌的耐药率达89.83%,对头孢唑啉、磺胺异噁唑和氨苄西林耐药率分别为81.36%、52.54%和44.07%,多重耐药率达55.93%。另外检出7株耐碳青霉烯类肠杆菌科细菌。测序结果显示,所有粪便...     

一株污水源多重耐药大肠杆菌的耐药性检测及全基因组测序分析

【背景】水体环境分布广、流动性强,是耐药菌和耐药基因传播的主要媒介。【目的】了解北方污水厂大肠杆菌携带的耐药基因及可移动遗传元件情况。【方法】从北方污水厂筛选出一株多重耐药大肠杆菌,通过药敏试验进行耐药性检验,采用96孔板法测定菌株的最小抑菌浓度,利用酶标仪探究亚抑菌浓度抗生素对菌株生长的影响,并对菌株进行全基因组测序,对其携带的耐药基因及可移动遗传元件进行预测。【结果】大肠杆菌WEC对四环素、环丙沙星、诺氟沙星和红霉素具有耐药性,亚抑菌浓度的四环素、环丙沙星和诺氟沙星能够延缓或抑制菌株的生长。WEC菌株的基因组中包含一条大小为4 782 114 bp的环状染色体和2个大小分别为60 306 bp (pWEC-1)和92 065 bp (pWEC-2)的环状质粒。菌株共携带129个耐药基因,其中128个位于染色体上,在染色体上预测到原噬菌体、基因岛及插入序列的存在,部分可移动遗传元件携带有耐药基因。质粒pWEC-1中无耐药基因,pWEC-2含有1个耐药基因,在质粒基因组中预测到原噬菌体和插入序列。【结论】污水源大肠杆菌WEC是一株多重耐药菌株,其基因组中携带耐药基因和多种可移动遗传元件...     

Emergence of OXA-48-Producing Klebsiella pneumoniae in Taiwan

The isolation of OXA-48-producing Enterobacteriaceae has increased dramatically in Mediterranean countries in the past 10 years, and has recently emerged in Asia. Between January 2012 and May 2014, a total of 760 carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) isolates were collected during a Taiwan national surveillance. Carbapenemases were detected in 210 CnSKP isolates (27.6%), including 162 KPC-2 (n = 1), KPC-3, KPC-17, and NDM-1 (n = 1 each), OXA-48 (n = 4), IMP-8 (n = 18), and VIM-1 (n = 24). The four bla _OXA-48 CnSKP isolates were detected in late 2013. Herein we report the emergence OXA-48-producing K. pneumoniae isolates in Taiwan. PFGE analysis revealed that the four isolates belonged to three different pulsotypes. Three isolates harboured bla _CTX-M genes and belonged to MLST type ST11. In addition, the plasmids belonged to the incompatibility group, IncA/C. One isolate belonged to ST116 and the plasmid incompatibility group was non-typeable. The sequence upstream of the bla _OXA-48 gene in all four isolates was identical to pKP_OXA-48N1, a bla _OXA-48-carrying plasmid. This is the first report of OXA-48-producing Enterobacteriaceae in Taiwan and the second report to identify bla _OXA-48 on an IncA/C plasmid in K. pneumoniae. Given that three isolates belong to the same pandemic clone (ST11) and possess the IncA/C plasmid and similar plasmid digestion profile that indicated the role of clonal spread or plasmid for dissemination of bla _OXA-48 gene, the emergence of OXA-48-producing K. pneumoniae in Taiwan is of great concern.