多重耐药菌在人类、动物和环境的耐药和传播机制

抗生素等抗菌药物的滥用在全球范围内造成了多重耐药菌的传播。多重耐药菌(Multidrug resistant organisms,MDRO)以及耐药基因(Antibiotic resistance genes,ARGs)可在人类、动物和环境之间进行传播,尤其是ARGs可以通过水平转移的方式在同种属或者不同种属的菌群之间进行传播,使得细菌耐药问题日益严重,耐药机制趋于复杂,疾病治疗更加困难,对人类公众健康造成严重的威胁。因此抗生素等抗菌药物的使用应加以规范。     

人类与病原菌的军备竞赛:NDM-1耐药基因与超级细菌

在人类历史上,每一次诸如鼠疫和肺结核病等瘟疫的大流行,都曾给人类的生存带来巨大的威胁。抗生素的应用使人类掌握了抵抗细菌感染的锐利"武器",但同时病原菌也通过突变和水平基因转移等方式产生了诸多耐药基因,从而获得了应对抗生素杀伤的坚固"盾牌";于是人类又不断地开发新式抗生素"武器"来破解病原菌的耐药"盾牌"——一场"军备竞赛"愈演愈烈。近来研究发现,携带编码NDM-1基因的耐药质粒不仅可以在细菌间转移,而且能使所在宿主菌成为可以耐受几乎全部抗生素的超级细菌。但是,凭借着日益进步的科技和医学,以及科学的用药策略,我们一定可以再次战胜超级细菌。     

肠杆菌科细菌耐药基因表达的遗传和环境调控

细菌耐药性是21世纪国际关注的重要问题,也是全球面临的重大挑战。肠杆菌科细菌是医院感染的重要病原菌之一。近年来,随着抗生素的大量使用,多种肠杆菌科耐药菌,尤其是多重耐药肠杆菌开始大量出现,对人类健康形成了日益严重的威胁。细菌可以通过耐药基因突变或水平转移的方式获得耐药性,通常情况下,可以通过已知的耐药机制预测相应的耐药表型。然而,最近有研究表明,遗传背景和环境因素能够影响耐药基因的表达,给定的基因型并不一定总是产生预期的耐药表型。这种基因型-表型分离的现象极大程度上限制了从遗传学角度预测耐药表型的能力。文中结合最新文献,从遗传背景和环境条件两个方面探讨了多种肠杆菌科细菌耐药基因的表达调控机制,以期为遗传学预测耐药表型以及临床指导用药提供一定的支持。     

sRNA调控细菌耐药相关基因表达研究进展

近年来随着抗菌药物的广泛应用,造成各种耐药菌、多重耐药菌甚至是超级细菌的出现,对抗菌治疗产生严重的威胁。sRNA是一类新发现的基因表达调控因子,通过与靶mRNA或靶蛋白配对,从而调控细胞的生理功能以应对各种环境变化。研究表明,sRNA能够在细菌耐药过程中(如阻碍抗生素进入细胞、将药物外排出菌胞)发挥重要的调控作用。就sRNA参与调控细菌耐药机制相关基因的表达研究展开系统综述,从而为阐明耐药机制及发现新的药物靶点提供有益参考。     

益生菌食品和益生菌补充剂的安全性

益生菌的安全性受到了很多关注,主要是围绕细菌易位引发的败血症和获得性耐药基因水平转移等问题.为了消除人们的担心,生产者需要对每株益生菌的安全性进行说明,因为每株益生菌的性状都是不同的.并且为了防止耐药病原菌的爆发,若益生菌携带有获得性耐药基因(如tetW),那么在没有排除此基因具有转移的可能性时,是不能被使用的.     

综述与专论：细菌的信号转导系统及其在耐药中的作用

耐药菌的日益增多给临床治疗带来巨大的困难,揭示耐药机制成为遏制耐药菌的基本环节。细菌的信号系统是菌体之间信息交流的主要渠道,在调控细菌耐药性方面发挥重要的作用。本文梳理了细菌双组分系统、群体感应系统、第二信使、吲哚等细菌信号系统(分子)与细菌耐药性的关系,总结了各信号系统调控细菌耐药性的机制和途径,包括调控生物膜的形成、调节药物外排泵的活性、激活抗生素灭活酶、提高耐药基因表达水平、促进耐药基因转移、修饰细胞壁结构等,涉及到细菌耐药的多个环节。各信号系统不仅可以独立调控耐药,还可以互相作用,形成调控网络,从多个层面调节细菌耐药性。因此,靶向细菌信号系统,阻断菌体之间的信号联络,有望成为遏制细菌耐药性日益严重的新策略。     

肠球菌耐万古霉素机制研究进展

肠球菌为革兰阳性（G＋）球菌,广泛分布于自然环境及人和动物消化道内,既往认为肠球菌是对人类无害的共栖菌。自20世纪80年代以来,肠球菌严重感染的发生率和病死率明显升高,肠球菌成为了院内感染的重要病原菌,不仅可引起尿路感染,皮肤软组织感染,甚至危及生命的腹腔感染、败血症、心内膜炎、脑膜炎等,在败血症中肠球菌为第三位的病原菌,仅次于凝固酶阴性葡萄球菌和金黄色葡萄球菌。由于肠球菌对多种抗菌药物具有天然耐药（固有耐药）和获得性耐药的特性,许多常用抗菌药物活性降低,往往造成临床治疗失败。为此,相研究对有关肠球菌的耐药机制的相关文献进行综述,以利于同道们进一步研究。     

抗生素耐药基因在畜禽粪便-土壤系统中的分布、扩散及检测方法

抗生素耐药基因作为一种新型的环境污染物已引起研究者的高度关注。畜禽养殖业长期将抗生素添加到饲料中,在促进动物生长、预防和治疗动物疾病等方面起了重要作用。这些抗生素大多数不能被动物完全吸收,在动物肠道中诱导出耐抗生素细菌和抗生素耐药基因,并随着粪便排出体外。畜禽粪便作为重要的抗生素、耐抗生素细菌和抗生素耐药基因储存库,通过堆粪、施肥等农业活动进入土壤环境中,可刺激土壤中耐抗生素细菌和抗生素耐药基因的富集。耐药基因借助于基因水平转移等方式在土壤介质中进一步传播扩散,甚至进入植物中随食物链传播,对生态环境和人类健康造成极大的威胁。为了正确评估抗生素耐药基因的生态风险,本文结合国内外相关研究,系统阐述了畜禽粪便-土壤系统中抗生素耐药基因的来源、分布及扩散机制,同时探讨了细菌耐药性的主要研究方法,指出堆肥化处理仍是目前去除抗生素耐药基因的主要手段,并对今后的研究方向进行展望。     

养殖动物及其相关环境耐药组的研究进展

畜牧养殖业中大量抗生素的使用,导致养殖动物及其相关环境中存在大量的耐药基因/耐药细菌。这些耐药基因可以借助基因水平转移等方式在环境中进一步扩散,甚至进入食品动物随食物链传播,对生态环境、食品安全和人类健康造成极大的威胁。随着基因组学研究手段的不断进步,养殖动物及其相关环境中耐药基因的多样性和生态学分布规律被广泛揭示。文中综述了相关领域耐药基因的研究进展,探讨了其对人体健康的潜在影响,并对未来的研究方向进行了展望。     

多耐药肺炎克雷伯菌获得性耐药基因检测及指标聚类分析

目的调查多耐药肺炎克雷伯菌中65种获得性耐药基因和7种可移动遗传元件遗传标记基因的存在状况,以及获得性耐药基因和可移动遗传元件遗传标记基因的相关性。方法收集绍兴地区六家医院分离的肺炎克雷伯菌共20株,采用PCR的方法分析65种β-内酰胺类、氨基糖苷类、喹诺酮类获得性耐药基因和7种转座子、插入序列、接合性质粒遗传标记基因,并用指标聚类分析(SPSS法)分析β-内酰胺类、氨基糖苷类和喹诺酮类获得性耐药基因与整合子、转座子、插入序列、接合性质粒遗传标记基因的相关性。结果 20株肺炎克雷伯菌共检测到14种获得性耐药基因(包括6种β-酰胺类获得性耐药基因、6种氨基糖苷类获得性耐药基因、2种喹诺酮类获得性耐药基因)和6种可移动遗传元件遗传标记基因(包括1种整合子遗传标记基因、3种转座子和插入序列基因遗传标记基因、2种接合性质粒遗传标记基因),其余52种基因均未检测到。SPSS法将上述阳性检出基因分成两大簇群。结论绍兴地区六家医院的多耐药肺炎克雷伯菌菌株对抗菌药物的耐药表型与获得性耐药基因相关,且可移动遗传元件的水平转移使细菌的耐药性在同种细菌菌株之间甚至不同种细菌菌株之间得以快速传播。获得性耐药基因与可移动遗传元件遗传标记基因的指标聚类分析显示:OXA-1、aac(6’)-Ⅰb、qnrB、IMP、aadA5、VEB、KPC、qnrS等基因与接合性质粒遗传标记traA相关,提示这些基因在F接合性质粒上;DHA、aph(3′)-Ⅰ等基因与转座子遗传标记tnpU、tnp513相关,提示它们位于转座子上;TEM-1、aac(3)-Ⅱ、qacE△1与接合性质粒遗传标记trbC相关,提示TEM-1、aac(3)-Ⅱ等基因和Ⅰ类整合子可能位于宽范围接合性质粒上;ant(3″)-Ⅰ、rmtB等基因与ISEcp1较为相关,提示这些基因位于插入序列上。     

Functional role of bacterial multidrug efflux pumps in microbial natural ecosystems

Multidrug efflux pumps have emerged as relevant elements in the intrinsic and acquired antibiotic resistance of bacterial pathogens. In contrast with other antibiotic resistance genes that have been obtained by virulent bacteria through horizontal gene transfer, genes coding for multidrug efflux pumps are present in the chromosomes of all living organisms. In addition, these genes are highly conserved (all members of the same species contain the same efflux pumps) and their expression is tightly regulated. Together, these characteristics suggest that the main function of these systems is not resisting the antibiotics used in therapy and that they should have other roles relevant to the behavior of bacteria in their natural ecosystems. Among the potential roles, it has been demonstrated that efflux pumps are important for processes of detoxification of intracellular metabolites, bacterial virulence in both animal and plant hosts, cell homeostasis and intercellular signal trafficking.     

Why are bacteria refractory to antimicrobials?

The incidence of antibiotic resistance in pathogenic bacteria is rising. Antibiotic resistance can be achieved via three distinct routes: inactivation of the drug, modification of the target of action, and reduction in the concentration of drug that reaches the target. It has long been recognized that specific antibiotic resistance mechanisms can be acquired through mutation of the bacterial genome or by gaining additional genes through horizontal gene transfer. Recent attention has also brought to light the importance of different physiological states for the survival of bacteria in the presence of antibiotics. It is now apparent that bacteria have complex, intrinsic resistance mechanisms that are often not detected in the standard antibiotic sensitivity tests performed in clinical laboratories. The development of resistance in bacteria found in surface-associated aggregates or biofilms, owing to these intrinsic mechanisms, is paramount.     

Differential epigenetic compatibility of qnr antibiotic resistance determinants with the chromosome of Escherichia coli

Environmental bacteria harbor a plethora of genes that, upon their horizontal transfer to new hosts, may confer resistance to antibiotics, although the number of such determinants actually acquired by pathogenic bacteria is very low. The founder effect, fitness costs and ecological connectivity all influence the chances of resistance transfer being successful. We examined the importance of these bottlenecks using the family of quinolone resistance determinants Qnr. The results indicate the epigenetic compatibility of a determinant with the host genome to be of great importance in the acquisition and spread of resistance. A plasmid carrying the widely distributed QnrA determinant was stable in Escherichia coli, whereas the SmQnr determinant was unstable despite both proteins having very similar tertiary structures. This indicates that the fitness costs associated with the acquisition of antibiotic resistance may not derive from a non-specific metabolic burden, but from the acquired gene causing specific changes in bacterial metabolic and regulatory networks. The observed stabilization of the plasmid encoding SmQnr by chromosomal mutations, including a mutant lacking the global regulator H-NS, reinforces this idea. Since quinolones are synthetic antibiotics, and since the origin of QnrA is the environmental bacterium Shewanella algae, the role of QnrA in this organism is unlikely to be that of conferring resistance. Its evolution toward this may have occurred through mutations or because of an environmental change (exaptation). The present results indicate that the chromosomally encoded Qnr determinants of S. algae can confer quinolone resistance upon their transfer to E. coli without the need of any further mutation. These results suggest that exaptation is important in the evolution of antibiotic resistance.     

Static recipient cells as reservoirs of antibiotic resistance during antibiotic therapy

How does taking the full course of antibiotics prevent antibiotic resistant bacteria establishing in patients? We address this question by testing the possibility that horizontal/lateral gene transfer (HGT) is critical for the accumulation of the antibiotic-resistance phenotype while bacteria are under antibiotic stress. Most antibiotics prevent bacterial reproduction, some by preventing de novo gene expression. Nevertheless, in some cases and at some concentrations, the effects of most antibiotics on gene expression may not be irreversible. If the stress is removed before the bacteria are cleared from the patients by normal turnover, gene expression restarts, converting the residual population to phenotypic resistance. Using mathematical models we investigate how static recipients of resistance genes carried by plasmids accumulate resistance genes, and how specifically an environment cycling between presence and absence of the antibiotic uniquely favors the evolution of horizontally mobile resistance genes. We found that the presence of static recipients can substantially increase the persistence of the plasmid and that this effect is most pronounced when the cost of carriage of the plasmid decreases the cell's growth rate by as much as a half or more. In addition, plasmid persistence can be enhanced even when conjugation rates are as low as half the rate required for the plasmid to persist as a parasite on its own.     

Bacterial efflux systems and efflux pumps inhibitors

It is now well established that bacterial resistance to antibiotics has become a serious problem of public health that concerns almost all antibacterial agents and that manifests in all fields of their application. Among the three main mechanisms involved in bacterial resistance (target modification, antibiotic inactivation or default of its accumulation within the cell), efflux pumps, responsible for the extrusion of the antibiotic outside the cell, have recently received a particular attention. Actually, these systems, classified into five families, can confer resistance to a specific class of antibiotics or to a large number of drugs, thus conferring a multi-drug resistance (MDR) phenotype to bacteria. To face this issue, it is urgent to find new molecules active against resistant bacteria. Among the strategies employed, the search for inhibitors of resistance mechanisms seems to be attractive because such molecules could restore antibiotic activity. In the case of efflux systems, efflux pump inhibitors (EPIs) are expected to block the pumps and such EPIs, if active against MDR pumps, would be of great interest. This review will focus on the families of bacterial efflux systems conferring drug resistance, and on the EPIs that have been identified to restore antibiotic activity.     

产超广谱β-内酰胺酶细菌中I类整合子的研究进展

产超广谱β-内酰胺酶(Extended-spectrum beta-lactamase, ESBLs)细菌的多重耐药性是临床用药的一大难题, 近年研究发现其耐药性的产生与整合子密切相关, 其中临床最常见、研究最深入的是I类整合子。整合子是一种可移动基因元件, 在整合酶的作用下捕捉外源基因盒并使之表达, 是具有基因整合和切除功能的天然克隆和表达系统。研究表明I类整合子可连续捕捉和整合多种耐药基因, 以质粒或转座子为载体在细菌之间传播耐药性, 使ESBLs细菌多重耐药趋势十分严峻。本文就I类整合子的结构特征、I类整合子对耐药基因盒的整合作用及其与ESBLs细菌耐药性的关系等方面进行综述。     

Transgenic hybrid aspen overexpressing the Atwbc19 gene encoding an ATP-binding cassette transporter confers resistance to four aminoglycoside antibiotics

Antibiotic-resistance genes of bacterial origin are invaluable markers for plant genetic engineering. However, these genes are feared to pose possible risk to human health by horizontal gene transfer from transgenic plants to bacteria, potentially resulting in antibiotic-resistant pathogenic bacteria; this is a considerable regulatory concern in some countries. The Atwbc19 gene, encoding an Arabidopsis thaliana ATP-binding cassette transporter, has been reported to confer resistance to kanamycin specifically as an alternative to bacterial antibiotic-resistance genes. In this report, we transformed hybrid aspen (Populus canescens × P. grandidentata) with the Atwbc19 gene. Unlike Atwbc19-transgenic tobacco that was only resistant to kanamycin, the transgenic Populus plants also showed resistance to three other aminoglycoside antibiotics (neomycin, geneticin, and paromomycin) at comparable levels to plants containing a CaMV35S-nptII cassette. Although it is unknown why the transgenic Populus with the Atwbc19 gene is resistant to all aminoglycoside antibiotics tested, the broad utility of the Atwbc19 gene as a reporter gene is confirmed here in a second dicot species. Because the Atwbc19 gene is plant-ubiquitous, it might serve as an alternative selectable marker to current bacterial antibiotic-resistance marker genes and alleviate the potential risk for horizontal transfer of bacterial-resistance genes in transgenic plants.     

Overexpression of an Arabidopsis thaliana ABC transporter confers kanamycin resistance to transgenic plants

Selectable markers of bacterial origin such as the neomycin phosphotransferase type II gene, which can confer kanamycin resistance to transgenic plants, represent an invaluable tool for plant engineering. However, since all currently used antibiotic-resistance genes are of bacterial origin, there have been concerns about horizontal gene transfer from transgenic plants back to bacteria, which may result in antibiotic resistance. Here we characterize a plant gene, Atwbc19, the gene that encodes an Arabidopsis thaliana ATP binding cassette (ABC) transporter and confers antibiotic resistance to transgenic plants. The mechanism of resistance is novel, and the levels of resistance achieved are comparable to those attained through expression of bacterial antibiotic-resistance genes in transgenic tobacco using the CaMV 35S promoter. Because ABC transporters are endogenous to plants, the use of Atwbc19 as a selectable marker in transgenic plants may provide a practical alternative to current bacterial marker genes in terms of the risk for horizontal transfer of resistance genes.     

Horizontal gene transfer contributes to the wide distribution and evolution of type II restriction-modification systems

Restriction modification (RM) systems serve to protect bacteria against bacteriophages. They comprise a restriction endonuclease activity that specifically cleaves DNA and a corresponding methyltransferase activity that specifically methylates the DNA, thereby protecting it from cleavage. Such systems are very common in bacteria. To find out whether the widespread distribution of RM systems is due to horizontal gene transfer, we have compared the codon usages of 29 type II RM systems with the average codon usage of their respective bacterial hosts. Pronounced deviations in codon usage were found in six cases:EcoRI,EcoRV,KpnI,SinI,SmaI, andTthHB81. They are interpreted as evidence for horizontal gene transfer in these cases. As the methodology is expected to detect only one-fourth to one-third of all horizontal gene transfer events, this result implies that horizontal gene transfer had a considerable influence on the distribution and evolution of RM systems. In all of these six cases the codon usage deviations of the restriction enzyme genes are much more pronounced than those of the methyltransferase genes. This result suggests that in these cases horizontal gene transfer had occurred sequentially with the gene for the methyltransferase being first acquired by the cell. This can be explained by the fact that an active restriction endonuclease is highly toxic in cells whose DNA is not protected from cleavage by a corresponding methyltransferase.