新生儿医院感染产超广谱β-内酰胺酶细菌流行状况及耐药性分析

目的了解新生儿医院感染中产超广谱β-内酰胺酶（ESBLs）细菌流行状况及耐药性,为预防和控制感染提供依据。方法对2011年1月至2013年12月间新生儿医院感染病原菌分布及耐药性进行回顾性分析;用VITEK-2 Compact微生物鉴定系统鉴定菌种和药敏试验。结果共检出病原菌192株,105株为肺炎克雷伯菌和大肠埃希菌,占54.7%;检出产ESBLs菌58株,全部来自肺炎克雷伯菌和大肠埃希菌;产ESBLs菌对青霉素类、头孢菌素类、单内酰环类抗菌药物高度耐药,耐药率〉80.0%,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低,耐药率〈20.0%,未检测到亚胺培南和美罗培南耐药株。结论产ESBLs肺炎克雷伯菌和大肠埃希菌是新生儿医院感染中主要的病原菌,且对常用抗菌药物耐药率较高,临床应加强病原菌的耐药性监测,合理使用抗菌药物。     

佳木斯地区女性泌尿系统感染大肠埃希菌耐药性分析

目的分析女性患者泌尿系统感染大肠埃希菌的耐药性,为临床合理使用抗生素提供依据。方法采用全自动微生物鉴定系统对女性泌尿系统感染患者分离出的病原菌进行鉴定和药敏分析。结果大肠埃希菌非产ESBLs株对氨苄西林、第一、二代头孢菌素类药品高度耐药。大肠埃希菌非产ESBLs株对碳青霉烯类药物美罗培南无耐药,对第三代头孢菌素敏感率高,耐药率低。产ESBLs大肠埃希菌,仅碳青霉烯类抗生素美罗培南敏感。结论女性泌尿系统感染大肠埃希菌的多重耐药性日趋严重,需加强对抗生素使用的规范化管理,合理使用抗菌药物,控制耐药菌的传播和流行。     

2921株大肠埃希菌的临床分布与耐药分析

目的了解近五年来本院分离的大肠埃希菌(ECO)的临床分布和耐药性变化,为临床合理治疗大肠埃希菌引起的感染提供参考。方法采用VITEK-32全自动微生物分析系统,对2009-2013年分离的大肠埃希菌进行菌株鉴定和药物敏感试验,用WHONET 5.4软件进行耐药统计分析。结果 2009-2013年本院共分离出2 921株ECO,2009-2012年大肠埃希菌主要分离自尿液,平均占29.4%,2013年大肠埃希菌主要分离自血液,占27.6%;2011-2013年产超广谱β-内酰胺酶(ESBLs)大肠埃希菌平均检出率为70.1%,高于2009-2010年的平均检出率64.1%(P0.05);主要来源于普外科和ICU,分别占22.1%、18.4%;非产ESBLs大肠埃希菌对头孢替坦、哌拉西林/他唑巴坦、亚胺培南的耐药率高于产ESBLs大肠埃希菌(P0.05),对本研究其他药物的耐药率,非产ESBLs大肠埃希菌低于产ESBLs大肠埃希菌(P0.05);产ESBLs大肠埃希菌对氨苄西林、头孢唑啉、头孢曲松、氨苄西林/舒巴坦的耐药率均90%,非产ESBLs大肠埃希菌对氨苄西林的耐药率70%。结论大肠埃希菌是临床常见致病菌,本市产ESBLs大肠埃希菌的分离率非常高,耐药问题十分严重,应加强合理使用抗菌药物管理,定期监测,控制耐药菌的产生,预防医院感染暴发流行。     

伤寒沙门菌耐药质粒体内接合转移的研究

目的研究伤寒沙门菌耐药质粒pRST98在小鼠体内向大肠埃希菌的接合转移,比较质粒在体内、外接合转移的异同。方法由于伤寒沙门菌是一种只对人类致病的病原菌,因此将伤寒沙门菌的耐药质粒pRST98导入遗传背景明确的鼠伤寒沙门菌低毒株RIA中,用接合子pRST98/RIA口饲BALB/c小鼠进行体内接合转移。结果在体外伤寒沙门菌很容易将pRST98转移给大肠埃希菌E.coliK12W1485(F-)RifrLac+,该接合子又可将pRST98转移给鼠伤寒沙门菌RIA,但在不同宿主菌中耐药标志的表达有差异。未经人工感染小鼠肠道分离的大肠埃希菌耐药情况严重,口饲pRST98/RIA后出现了部分耐药标志与pRST98耐药谱相同的大肠埃希菌,但有些抗生素的耐药标记未能表达。质粒检测显示体内形成的接合子均含耐药质粒pRST98。结论伤寒沙门菌耐药质粒pRST98在动物体内、外均可转移给大肠埃希菌,但同一质粒在体内、外大肠埃希菌株中耐药标志表达有差异,即使在同一小鼠体内分离的不同接合子,pRST98/E.coli菌株耐药性亦有不同,显示耐药质粒表达的多样性和复杂性。     

大肠埃希菌耐药性水平传播实验研究

目的研究重症监护病房（ICU）患者标本中分离的大肠埃希菌的耐药情况以及耐药性水平传播的实验研究。方法采取双纸片法（K-B）检测细菌的耐药性;产超广谱β-内酰胺酶（ESBLs）大肠埃希菌为供体菌,耐利福平大肠埃希菌（对其他抗生素敏感）作为受体菌进行接合实验;采用聚合酶链反应（PCR）技术扩增整合子和耐药基因。结果30株大肠埃希菌中产ESBLs菌株检出率为46．7％;接合培养后,接合菌携带23kb和25kb大质粒,而无供体菌中一系列小质粒;供体菌和接合菌均携带I型整合子。结论大肠埃希菌耐药性严重,且呈多重耐药性;产ESBLs菌株可通过质粒和整合子将耐药基因转移给敏感菌,导致耐药性传播。     

社区与医院感染中肺炎克雷伯杆菌和大肠埃希菌耐药性分析

目的探讨社区和医院感染中肺炎克雷伯杆菌和大肠埃希菌产ESBLs的情况及耐药特性。方法采用体外扩散确证试验检测ESBLs,同时用Micro scan wat RA way-40系统全自动细菌鉴定/药敏分析仪及K-B琼脂扩散法进行细菌鉴定和体外药敏试验。结果社区感染标本中分离出肺炎克雷伯杆菌79株,产ESBLs20株,阳性率为25.3%,大肠埃希菌177株,产ESBLs27株,阳性率为15.3%;医院感染标本中分离出肺炎克雷伯杆菌82株,产ES-BLs33株,阳性率为40.2%,大肠埃希菌135株,产ESBLs42株,阳性率为31.1%,社区与医院感染菌株产ESBLs比较差异均有统计学意义(P均<0.05);ESBLs阳性菌株对多种抗生素耐药,其耐药性明显高于ESBLs阴性菌株。结论肺炎克雷伯杆菌和大肠埃希菌产ESBLs菌株在临床分离率较高,医院感染标本要显著高于社区感染标本,并且对多种抗生素具有高度耐药性,产ESBLs菌株耐药性显著高于不产ESBLs菌株,临床上应加强对ESBLs的控制,以防感染流行。     

医院与社区获得性感染大肠埃希菌耐消毒剂基因比较分析

目的 比较在本地区医院感染与社区获得性大肠埃希菌中耐消毒剂基因的流行情况.方法 收集从临床标本中分离出的大肠埃希菌112株,根据感染途径不同,将其分为医院与社区获得性两组,用PCR方法检测耐消毒剂基因qacE△1,并进行组间检出率比较.结果 本地区医院与社区获得性感染大肠埃希菌耐消毒剂基因的携带率分别为58.1％(43/74)和23.7％ (9/38),组间比较差异有统计学意义(P ＜0.05);74株医院获得性大肠埃希菌中,产ESBL率为71.6％(53/74),38株社区获得性大肠埃希菌中,产ESBL率为39.5％ (15/38).医院与社区获得性产ESBL大肠埃希菌耐消毒剂基因qacE△1检出率分别为64.2％(34/53)与6.7％(1/15),组间比较差异亦有统计学意义(P＜0.01).结论 医院获得性感染大肠埃希菌耐消毒剂基因的携带率高于社区获得性大肠埃希菌,产ESBL阳性菌株的携带率显著高于产ESBL阴性菌株,这可能是由于医院环境中消毒剂选择压力和/或携带耐消毒剂基因的菌株在医院内水平传播速度较快的结果.     

医院感染病原菌及耐药性监测报告

从３９０４ 例住院病人标本中分离出医院内感染病原菌７８１ 株,结合临床常用的１４ 种抗菌药物药敏试验结果进行整理分析。结果,革兰阳性球菌所占比例呈上升趋势,革兰阴性杆菌呈下降趋势。引起医院感染的主要病原菌为真菌、大肠埃希菌、克雷伯菌、肠球菌、金黄色葡萄球菌。２ 年间金黄色葡萄球菌对青霉素的耐药率已＞ ９３ ％ ,对第三代喹诺酮类的耐药率下降了１６．６６ ％ ～４０．８３ ％ 。肠球菌对万古霉素的耐药率上升了２７．５９ ％ 。克雷伯菌、沙雷菌、大肠埃希菌对头孢菌素类、第三代喹诺酮类的耐药率呈上升趋势。金黄色葡萄球菌、表皮葡萄球菌、肠杆菌属、铜绿假单胞菌对阿米卡星的耐药率呈下降趋势。     

重庆地区儿童感染患者11039株大肠埃希菌的临床分布及耐药性

目的分析2010-2015年重庆地区儿童感染的11 039株大肠埃希菌的临床分布特征及耐药性,为合理应用抗菌药物和预防控制医院感染提供依据。方法分析大肠埃希菌对19种抗菌药物的耐药性,采用BD Phoenix 100 MIC法结合K-B纸片扩散法进行药敏试验,按美国临床实验室标准化委员会(CLSI)标准判断结果。结果大肠埃希菌总检出率为13.53%;大肠埃希菌在呼吸病房和新生儿病房的检出率高于其他病房;以痰标本多见,占62.22%(6869/11039);大肠埃希菌对氨苄青霉素耐药率最高(90.33%),对美罗培南、亚胺培南的耐药率低,分别为0.81%和0.78%。ESBLs平均检出率为50.98%(5628/11039)。结论大肠埃希菌的耐药性呈上升趋势,呼吸病房和新生儿病房是预防控制的重点科室。     

大肠埃希菌在肿瘤患者肠外的分布及耐药谱分析

目的：了解大肠埃希菌在肿瘤患者肠外的分布和感染情况及耐药性。方法：参照全国临床检验操作规程,采用K-B法对云南省肿瘤医院58例肿瘤患者继发大肠埃希菌感染进行分析及对9种抗生素的耐药谱测定。结果：各类肿瘤患者中,以宫颈癌及继发大肠埃希菌感染多见,其中,宫颈癌为28.30%。肺癌为26.87%。从标本来源来看,以尿液标本最多,为63.79%,其次为痰液12.07%及分泌物12.07%。结论：大肠埃希菌在肿瘤患者肠外分布广泛,所致感染较严重,经耐药谱测定发现大肠埃希菌多重耐药类型多,提示对肿瘤患者治疗应重视局部微生态平衡及控制感染。     

Characteristics of new pKMR-plasmids detected in natural strains of Enterobacteriaceae

pKMR-plasmids controlling the antibiotic resistance and adhesive properties were isolated from clinical strains of E. coli O26 and O124, and Sh. sonnei. Two of them, i.e. pKMR 207 and pKMR 208 were conjugative. On conjugation they jointly transferred the features of the antibiotic resistance and capacity for production of the colonization antigen. The studies on transformation of E. coli K 12 802 with the plasmid DNA of E. coli O124 showed that the antibiotic resistance and colonization properties in E. coli O124 were controlled by the nonconjugative plasmid pKMR 209. It was found that plasmids pKMR 207 and pKMR 208 had the fi(-)-phenotype. None of the plasmids allotted the host cells sensitivity to the donor specific phages of the incompatibility groups F, N, P, W, and I. Probably, the plasmids did not belong to these incompatibility groups. When the cells of E. coli K 12 802 were transformed with the plasmid DNA of the wild strain to the hemolytic strain of S. typhimurium with multiple antibiotic resistance, 3 pKMR 210 plasmids with different markers of the antibiotic resistance were detected in the transformants. One of the plasmids controlled both the drug resistance and the capacity for production of hemolysin. The ability of the detected pKMR plasmids to inhibit fertility and relation to the donor specific phages was studied.     

Plasmids in Escherichia coli controlling citrate-utilizing ability.

The citrate-utilizing ability of 19 out of 22 citrate-positive Escherichia coli strains isolated from pig sewage was transferred via conjugation to E. coli K-12. The conjugal transfer of citrate-utilizing (Cit) abilities was thermosensitive and concurrent with transfer of drug resistance. Weakly citrate-positive colonies were readily obtained in conjugation experiments. Their Cit characters could be transmitted to the other E. coli strains at a similar frequency in the retransfer experiments, and the transconjugants obtained still showed same characteristic growth on Simmons citrate agar plates. The 19 thermosensitive plasmids conferring citrate utilization and drug resistance were Fi-, and 16 of these plasmids belonged to incompatibility group H1. However, occasionally two conjugative plasmids (pOH3122-1 and pOH3124-1) carrying only the citrate utilization were also obtained in the conjugation experiments, and they were Fi+ and compatible with 19 reference R plasmids. In the two citrate-positive E. coli strains, it was suggested that the conjugative Cit plasmid showing Fi+ character and the more thermosensitive H1 plasmid conferring both the Cit character and drug resistance coexisted in the strain. The characterization of citrate utilization plasmids derived from pig farm sewage is discussed.     

Natural plasmid transformation in<Emphasis Type="Italic">Escherichia coli</Emphasis>

Although Escherichia coli does not have a natural transformation process, strains of E. coli can incorporate extracellular plasmids into cytoplasm 'naturally' at low frequencies. A standard method was developed in which stationary phase cells were concentrated, mixed with plasmids, and then plated on agar plates with nutrients which allowed cells to grow. Transformed cells could then be selected by harvesting cells and plating again on selective agar plates. Competence developed in the lag phase, but disappeared during exponential growth. As more plasmids were added to the cell suspension, the number of transformants increased, eventually reaching a plateau. Supercoiled monomeric or linear concatemeric DNA could transform cells, while linear monomeric DNA could not. Plasmid transformation was not related to conjugation and was recA-independent. Most of the E. coli strains surveyed had this process. All tested plasmids, except pACYC184, could transform E. coli. Insertion of a DNA fragment containing the ampicillin resistance gene into pACYC184 made the plasmid transformable. By inserting random 20-base-pair oligonucleotides into pACYC184 and selecting for transformable plasmids, a most frequent sequence was identified. This sequence resembled the bacterial interspersed medium repetitive sequence of E. coli, suggesting the existence of a recognition sequence. We conclude that plasmid natural transformation exists in E. coli.     

Plasmids in Escherichia coli controlling citrate-utilizing ability.

The citrate-utilizing ability of 19 out of 22 citrate-positive Escherichia coli strains isolated from pig sewage was transferred via conjugation to E. coli K-12. The conjugal transfer of citrate-utilizing (Cit) abilities was thermosensitive and concurrent with transfer of drug resistance. Weakly citrate-positive colonies were readily obtained in conjugation experiments. Their Cit characters could be transmitted to the other E. coli strains at a similar frequency in the retransfer experiments, and the transconjugants obtained still showed same characteristic growth on Simmons citrate agar plates. The 19 thermosensitive plasmids conferring citrate utilization and drug resistance were Fi-, and 16 of these plasmids belonged to incompatibility group H1. However, occasionally two conjugative plasmids (pOH3122-1 and pOH3124-1) carrying only the citrate utilization were also obtained in the conjugation experiments, and they were Fi+ and compatible with 19 reference R plasmids. In the two citrate-positive E. coli strains, it was suggested that the conjugative Cit plasmid showing Fi+ character and the more thermosensitive H1 plasmid conferring both the Cit character and drug resistance coexisted in the strain. The characterization of citrate utilization plasmids derived from pig farm sewage is discussed.     

Transposon Tn10-like tetracycline resistance determinants in Haemophilus parainfluenzae.

Tetracycline resistance (Tcr) determinants from three different strains of Haemophilus parainfluenzae expressed 10-fold higher levels of resistance when mated into Escherichia coli. No plasmid was found in any of the E. coli recipients, even in matings in which a plasmid was identified in the donor Haemophilus sp. The Tcr determinant from Haemophilus sp. caused instability of resident plasmids in the recipient E. coli: all plasmids were lost within 30 generations in antibiotic-free media. However, by serial subculture in antibiotics, stable resident plasmids were obtained which carried the Tcr determinant from Haemophilus sp. and were transferable by conjugation and transformation among E. coli strains. All Haemophilus determinants hybridized with a probe for the Tcr determinant on Tn10, which bears inducible Tcr. However, Haemophilus determinants were constitutively resistant to tetracycline in the Haemophilus donors and in the E. coli recipients. This constitutive expression was recessive to wild-type Tn10 in the same cell, indicating that the constitutive phenotype resulted from the absence of an active repressor. Restrictive enzyme analysis of various E. coli plasmid derivatives bearing a Tcr determinant from Haemophilus sp. demonstrated that the inserted DNA was of similar size (8.95 to 9.35 kilobases), close to that of Tn10. Heteroduplex analysis and DNA:DNA hybridization confirmed that the Tcr determinant from Haemophilus sp. had greater than 90% homology with the Tn10 determinant, including the DNA sequence for the repressor.     

杭州地区发酵乳制品中乳酸菌发生耐药传播的安全性研究

目的对杭州地区市售发酵乳制品中分离鉴定的乳酸菌进行耐药传播的安全性分析,旨在揭示发酵乳制品中是否存在可传递耐药基因的超级耐药菌。方法自行分离鉴定的耐药乳酸菌,提取质粒并电泳分析是否存在质粒;以耐受叠氮化钠的大肠埃希菌J53作为受体菌进行质粒接合试验;若乳酸菌存在耐药现象,发现存在耐药质粒,且耐药性可通过质粒传播,评定为3级。乳酸菌存在耐药现象,发现存在耐药质粒,但接合试验未能证明耐药性可通过质粒传播,评定为2级。乳酸菌存在耐药现象,但未检测出耐药质粒,评定为1级。结果美丽健产品中分离的双歧杆菌（MLJ-G-2）和乳杆菌（MLJ-G-1）检测出含有质粒,但不会发生耐药转移,三种菌耐药危害等级分别为2、2、1。伊利产品中分离的双歧杆菌（YL-G-3）、乳杆菌（YL-G-1）、嗜热链球菌（YL-Q）检测出含有质粒,但不会发生耐药转移,四种菌耐药危害等级分别为2、2、1、2。味全产品中分离的双歧杆菌（WQ-G-3）、乳杆菌（WQ-G-1）、乳杆菌（WQ-G-2）、嗜热链球菌（WQ-Q）均检测出含有质粒,其中乳杆菌（WQ-G-1）、乳杆菌（WQ-G-2）会发生耐药转移,四种菌耐药危害等级分别为2、3、3、2。光明产品中分离的乳杆菌（GM-G-2）、乳杆菌（GM-G-3）、嗜热链球菌（GMQ）检测出含有质粒,乳杆菌（GM-G-2）会发生耐药转移,四种菌耐药危害等级分别为2、1、3、2。蒙牛产品中只分离的嗜热链球菌（MN-Q）检测出含有质粒,不会发生耐药转移,耐药危害等级为2。结论发酵乳制品中分离所得的乳酸菌81.2%的菌能检测出质粒,耐药性可能与质粒相关,存在潜在的生物安全威胁;18.8%的菌的耐药性可通过质粒接合发生传播,存在直接的生物安全威胁。     

Incompatibility Exhibited by Colicin Plasmids E1, E2, and E3 in Escherichia coli

Escherichia coli strains were made multiply colicinogenic for the colicin plasmids E1, E2, or E3 (Col E1, Col E2, or Col E3, respectively) by both a deoxyribonucleic acid transformation system and bacterial conjugation. The multiply colicinogenic bacteria constructed exhibited an immunity to the colicins produced by all the plasmids they carried and also produced colicins corresponding to all the plasmids they carried. An incompatibility was observed among the plasmids. In doubly colicinogenic cells where the presence of two plasmids was established, Col E2 was lost more frequently than Col E3. In triply colicinogenic cells, Col E1, Col E2, and Col E3 were lost, with Col E3 being lost least frequently. A significant reduction in the acquisition of a conjugationally transferred Col E1 plasmid by cells colicinogenic for Col E1 was demonstrated.     

Survey of modifying enzymes and plasmids in amikacin-resistant Serratia marcescens

Forty amikacin-resistant strains of Serratia marcescens isolated from four different hospitals (A, B, C, and D) were examined for modifying enzymes and plasmids. Twenty-one of the isolates produced acetyltransferase that modified amikacin. Eighteen of the 21 acetyltransferase-bearing isolates were from different inpatients in hospital A and the other three were from hospital C. Amikacin resistance was mediated by conjugative plasmid of 24 megadaltons in 15 of the 18 acetyltransferase-bearing isolates of hospital A and by nonconjugative plasmids, derivatives of the 24-megadalton plasmids, in the remaining three isolates of the same hospital. The 24-megadalton plasmid determined aminoglycoside acetyltransferase (6') IV. This plasmid-borne enzyme conferred amikacin resistance on S. marcescens but not on Escherichia coli K12. The frequency of transfer of the 24-megadalton plasmid from the S. marcescens isolate to E. coli K12 by conjugation was approximately 10(-7) (transconjugants/donors) and was 0.1% of that between E. coli strains. In acetyltransferase-bearing isolates from hospital C, the enzyme was mediated by a nonconjugative plasmid in one case and could not be associated with a plasmid in the remaining two cases. Neither enzymes nor plasmids could be associated with amikacin resistance of the isolates of the other two hospitals.     

Effect of ColV plasmids on the hydrophobicity of Escherichia coli

Abstract The hydrophobicity of E. coli strains carrying or lacking the colicin V ( ColV ) plasmids, ColV , I-K94 or ColV -K30 was assayed. ColV ⁺ derivatives of strain 1829, produced by conjugation or transformation, were more hydrophobic than either the original 1829 parental strain or a Col ^- derivative formed by curing 1829 ColV -K30 of its plasmid by an SDS/high temperature growth technique. Transfer of ColV into other E. coli strains also led to increased hydrophobicity. This effect of ColV plasmids was observed for organisms grown at 37°C; ColV ⁺ and ColV^- strains did not differ in hydrophobicity of grown at 21°C. This finding and other studies suggest that sex pili may be involved in the increased hydrophobicity.     

Incidence and transfer of R-plasmids at a hospital in Saudi Arabia

One hundred and fifty Gram-negative bacteria isolated from patient specimens at King Faisal Specialist Hospital were examined for their ability to transfer antibiotic resistance plasmids to a sensitive Escherichia coli recipient in conjugation and transformation experiments. Agarose gel electrophoresis was used to enumerate and size the R-plasmids found, and Southern DNA hybridization was used to assess similarities between antibiotic resistance plasmids from different bacteria and sources. Of the bacterial isolates tested 65% contained plasmids, 70% of these transferred antibiotic resistance to E. coli, and 40% transferred multiple, linked resistances on R-plasmids. DNA hybridization of these R-plasmids demonstrated widespread similarities between plasmids from different bacterial genera and from different hospital locations. In particular, a gene encoding ampicillin resistance appeared especially widespread, indicating that a transposon may be mediating transmission of this resistance.