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肺炎克雷伯菌(Klebsiella pneumoniae)是重要的条件致病菌,近年来肺炎克雷伯菌感染在医院内感染中所占的比率持续上升,耐药率也不断攀升,这给临床治疗带来极大的困难。肺炎克雷伯菌发生耐药的重要机制之一就是其细胞膜上存在的外排泵系统,它们将渗入细菌体内的药物不断泵出,导致菌体内的药物浓度过低,不足以发挥抗菌作用。本文主要针对外排泵介导肺炎克雷伯菌的耐药现状,外排泵的分子结构和基因调节,外排泵抑制剂以及传统中药在耐药菌治疗方面的应用等做系统性梳理,以期为临床治疗耐药肺炎克雷伯菌提供一些新思路。 相似文献
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肺炎克雷伯菌是目前临床上最主要的耐药致病菌之一,对人类健康造成了很大威胁.近年来,细菌耐药成为治疗肺炎克雷伯菌感染的主要难题,尤其是高毒力、高耐药性肺炎克雷伯菌的出现对临床工作造成了巨大挑战,而研究表明其耐药基因和毒力基因主要由可移动遗传元件携带而传播.因此,为了更好地认识及防控肺炎克雷伯菌感染,本文对肺炎克雷伯菌基因... 相似文献
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目的了解碳青霉烯类耐药肺炎克雷伯菌及耐药机制。方法对2012-2013年临床分离的耐碳青霉烯类肺炎克雷伯菌共计12株进行分析,药敏采用MIC方法检测,用WHONET 5.6软件进行分析,KPC表型检测采用改良Hodge试验,基因检测采用PCR方法。结果 12株碳青霉烯类耐药肺炎克雷伯菌改良Hodge试验阴性,基因测序为KPC-2型。结论 KPC-2基因是引起本院肺炎克雷伯菌耐药的主要原因。 相似文献
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目的 分析肺炎克雷伯菌所致血流感染患者的科室分布及其病原菌耐药性特征,为指导临床合理应用抗菌药物,有效控制感染提供依据。方法 选择2014—2016年大连医科大学附属第一医院送检血液标本中分离得到的289株肺炎克雷伯菌,对其进行细菌鉴定、药敏试验及ESBL确认试验,分析肺炎克雷伯菌所致血流感染的科室分布特征及其病原菌耐药性变迁。结果 患者血液中肺炎克雷伯菌检出率以急诊科(24.91%)和ICU为最高(23.88%)。3年中肺炎克雷伯菌对碳青霉烯类抗生素和阿米卡星耐药率较低,均在20.00%左右。产ESBL肺炎克雷伯菌共135株,占46.71%,对常用抗生素的耐药率均显著高于非产ESBL菌株(P<0.01)。碳青霉烯类抗生素耐药菌株对常用抗生素耐药率均高于敏感菌株(P<0.01),对四环素、复方新诺明和阿米卡星耐药率相对较低,分别为66.10%、66.10%、71.19%。结论 我院2014—2016年患者血液中肺炎克雷伯菌检出率以急诊科和ICU为最高。该菌对碳青霉烯类抗生素及阿米卡星的耐药率较低,碳青霉烯类抗生素耐药菌株对四环素、复方新诺明和阿米卡星尚有一定敏感性。 相似文献
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目的 调查血液分离的肺炎克雷伯菌的耐药谱.方法 收集温州医学院附属第一医院2005年1月至2009年9月间血液分离的肺炎克雷伯菌,采用全自动微生物分析仪对肺炎克雷伯菌进行菌种鉴定和药敏试验,超广谱β-内酰胺酶的检测采用仪器法.舒普深和美洛培南的药敏试验采用K-B法.结果 80株分离自血液的肺炎克雷伯菌主要分离自患有肝胆疾病、血液系统疾病、呼吸系统疾病和神经系统疾病的患者,分别占20.0%、17.5% 、15.0%和13.7%.80株肺炎克雷伯菌中,10株ESBLs阳性,阳性率为12.5%(10/80).除肺炎克雷伯菌对氨苄西林100%耐药外,对其他15种被测抗菌药物的耐药率全部低于20%,所有被测菌株对亚胺培南和美洛培南全部敏感,对其他9种抗菌药物的耐药率也低于10%.结论 血液分离的肺炎克雷伯菌主要来自患有肝胆疾病、血液系统疾病和神经系统疾病的患者.血液分离的肺炎克雷伯菌的ESBLs检出率非常低,且对常用抗菌药物的耐药率非常低. 相似文献
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【目的】对大熊猫源肺炎克雷伯菌进行耐药性及分子分型分析,掌握肺炎克雷伯菌在大熊猫圈养种群中的耐药和流行情况,指导临床用药。【方法】对2018–2019年收集到的178株大熊猫源肺炎克雷伯菌使用纸片扩散法(K-B法)分析耐药表型,使用Wafergen Smartchip超高通量荧光定量PCR法分析其耐药基因和可移动遗传元件,使用多位点序列分型(MLST)法分析其序列类型(ST)。【结果】178株大熊猫源肺炎克雷伯菌对多西环素耐药率最高(15.2%),而且2019年分离到的肺炎克雷伯菌对头孢噻肟、亚胺培南和阿奇霉素的耐药性显著高于2018年(P<0.05);检出耐药基因106种(106/227),可移动遗传元件11种(11/19),涉及的耐药机制主要为外排泵(42.0%)、抗生素失活(41.8%)和改变作用靶位(16.2%);MLST分型显示大熊猫源肺炎克雷伯菌主要分为42个不同的ST型,且ST型与耐药性具有一定的相关性。【结论】从2018年到2019年大熊猫源肺炎克雷伯菌对β-内酰胺类和大环内酯类抗生素耐药率有所增加,耐药机制以外排泵和抗生素失活为主。ST17、ST23和ST400... 相似文献
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目的:探讨内蒙古地区临床危重患者常见感染细菌耐药基因的检测及耐药性相关因素,以便临床合理运用抗菌药物,为病原菌感染的预防和控制提供依据。方法:选取2010年1月至2013年1月在我院重症监护室治疗的病例中检测出的215株细菌为研究对象,运用相关的检测手段分析细菌的耐药性和耐药基因情况。结果:经过临床的检测后得出大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌分别为85株、55株和75株,其中产ESBLs大肠埃希菌54株,非产ESBLs大肠埃希菌31株;产ESBLs肺炎克雷伯菌15株,非产ESBLs肺炎克雷伯菌40株。大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌对美罗培南、亚胺培南的敏感性最高,且在产与非产ESBLs菌株耐药上比较有差异性(P0.05);产与非产ESBLs菌株耐药基因检测方面比较无明显差异性(P0.05)。结论:大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌均存在多重耐药情况,且耐药与喹诺酮耐药机制有一定的相关性。 相似文献
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肺炎克雷伯菌是肠杆菌科家族中的一员,在各种环境中广泛存在,可导致诸如奶牛乳房炎在内的多种动物疫病,引起人类的肺炎、尿路感染、菌血症、伤口性感染和化脓性脓肿在内的多种临床感染。该菌对抗生素的耐受日趋严重,而且高毒力菌株不断出现,给该菌的防控带来了巨大挑战。噬菌体是一种裂解细菌的病毒,因其具有治疗耐药细菌感染的潜力而备受关注,世界各地均有使用噬菌体成功治疗耐药细菌感染的案例。本文基于国内外对肺炎克雷伯菌及其噬菌体的研究数据,综述了肺炎克雷伯菌的流行病学调查情况和噬菌体在治疗肺炎克雷伯菌感染方面的应用,以期为基于肺炎克雷伯菌噬菌体的抗菌研究和临床应用提供参考。 相似文献
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摘要 目的:探讨与分析呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素。方法:选择2015年1月到2020年2月本院诊治的呼吸道感染患者65例作为研究对象,收集患者的临床样本进行细菌分离与耐药分析,调查患者的临床资料并进行危险因素分析。结果:在呼吸道感染患者65例中,分离出多重耐药菌肺炎克雷伯菌32株,占比49.2 %,其中下呼吸道、上呼吸道、灌洗液、血液标本分别占50.0 %、9.4 %、25.0 %、6.3 %。32株多重耐药菌肺炎克雷伯菌对头孢曲松、头孢呋辛、氨苄西林、头孢吡肟、头孢噻肟的耐药率分别为71.9 %、87.5 %、96.9 %、84.4 %、81.3 %,对阿米卡星、头孢替坦、左氧氟沙星、亚胺培南、环丙沙星的敏感率分别为59.4 %、68.8 %、81.3 %、75.0 %、81.3 %。非条件 Logistic回归分析显示血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论:多重耐药菌肺炎克雷伯菌感染在呼吸道感染患者中比较常见,对头孢呋辛、氨苄西林的耐药率比较高,对左氧氟沙星、环丙沙星的敏感率比较高,血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素。 相似文献
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Three pulp and paper mill processing plants were evaluated for fecal coliform and Klebsiella pneumoniae bacterial concentrations. Freshwater consumed by paper industries contained minimum detectable levels of K. pneumoniae, less than 10 organisms per 100 ml. Elevated concentrations of K. pneumoniae could be traced from early pulping stages to water processing reuse systems. Concentrations of K. pneumoniae (thermotolerant and thermointolerant) ranged from 40,000 organisms per 100 ml to an estimated 3 x 10(6) organisms per 100 ml. K. pneumoniae biotyping provided evidence for the selective growth and persistence of K. pneumoniae from the initial wood washing stages through to the final effluent discharge. Wastewater treatment had limited effects in reducing K. pneumoniae concentrations. K. pneumoniae levels ranged from 40 organisms per 100 ml to an estimated 10(6) organisms per 100 ml. The presence of K. pneumoniae in water indicates degraded water quality, and its significance with regard to human health effects has yet to be examined. 相似文献
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The Escherichia coli single-stranded DNA binding (SSB) protein is a non-sequence-specific DNA binding protein that functions as an accessory factor for the RecA protein-promoted three-strand exchange reaction. An open reading frame encoding a protein similar in size and sequence to the E. coli SSB protein has been identified in the Streptococcus pneumoniae genome. The open reading frame has been cloned, an overexpression system has been developed, and the protein has been purified to greater than 99% homogeneity. The purified protein binds to ssDNA in a manner similar to that of the E. coli SSB protein. The protein also stimulates the S. pneumoniae RecA protein and E. coli RecA protein-promoted strand exchange reactions to an extent similar to that observed with the E. coli SSB protein. These results indicate that the protein is the S. pneumoniae analog of the E. coli SSB protein. The availability of highly-purified S. pneumoniae SSB protein will facilitate the study of the molecular mechanisms of RecA protein-mediated transformational recombination in S. pneumoniae. 相似文献
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N A Zigangirova A L Gintsburg E V Chetina S V Prozorovski? 《Zhurnal mikrobiologii, epidemiologii, i immunobiologii》1991,(11):20-24
A system for the rapid detection of M. pneumoniae, the causative agent of pneumonia in humans, has been developed. This system is based on the amplification of M. pneumoniae chromosomal DNA sequences in the polymerase chain reaction (PCR). The use of two primer sets, for nucleotide sequences of adhesion protein P1 and for nucleotide sequences of variable regions of the 16S ribosomal RNA, has permitted the detection of individual M. pneumoniae cells. The application of this technique for the study of simulated clinical material has shown that PRC is a sensitive and reliable assay and may be useful for the early detection of M. pneumoniae in infectious clinical material (blood and sputum samples). 相似文献
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As early as the 1940s, erythema multiforme exudativum (Stevens-Johnson syndrome) and hemolytic anemia were associated with outbreaks of atypical pneumonia, a disease later found to be caused by Mycoplasma pneumoniae. Epidemiologic evidence has also associated neurological complications, especially aseptic meningitis and meningoencephalitis, with M. pneumoniae infections. Urticarial and morbilliform skin rashes often appear late in the course of M. pneumoniae pneumonia. A multitude of other complications have been ascribed to M. pneumoniae infections, often reported as case reports diagnosed by serologic antibody titers only. More systematic investigations are needed to assess the frequency of complications to M. pneumoniae infections. Isolation of the agent, not only serologic titer rises, should be required before a syndrome is attributed to M. pneumoniae infection. 相似文献
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Mycoplasma pneumoniae infections occur both endemically and epidemically, and macrolide resistance has been spreading for 10 years worldwide. A substantial increased incidence of M. pneumoniae infections has been reported in several countries since 2010. Whether this increased incidence is attributed to different or to the same M. pneumoniae genotype is unknown. We have developed a multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) for the molecular typing of M. pneumoniae isolates. In this study, the MLVA typing method was modified and validated to be applicable directly to respiratory tract specimens without culture. This method was applied to 34 M. pneumoniae-positive specimens received at the Bordeaux Hospital, France, between 2007 and 2010 in an endemic setting, and to 63 M. pneumoniae-positive specimens collected during an epidemic surge of M. pneumoniae infections in 2010 in Jerusalem, Israel. The M. pneumoniae endemic spread was shown to be polyclonal in France, with 15 MLVA types identified. Strikingly, the Israeli epidemic surge was also a multi-clonal phenomenon, with 18 circulating MLVA types. The macrolide resistance-associated substitution, A2058G, was found in 22% of the Israeli patients. Macrolide-resistant M. pneumoniae belonged to four MLVA types, the MLVA type Z being the most frequent one. An association between the MLVA type Z and macrolide resistance might exist since macrolide resistance was present or generated during the course of illness in all patients infected with this MLVA type. In conclusion, the discriminatory power of the MLVA showed that the spread of M. pneumoniae strains in France in an endemic setting was polyclonal as well as the surge of M. pneumoniae infections in Israel in 2010. 相似文献
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Evaluation of real-time quantitative PCR for identification and quantification of Chlamydia pneumoniae by comparison with immunohistochemistry. 总被引:4,自引:0,他引:4
Chlamydia pneumoniae is a common cause of community-acquired pneumonia and it has been associated with atherosclerosis. C. pneumoniae has usually been diagnosed by serology using a microimmunofluorescence test, but more recently polymerase chain reaction (PCR) has been viewed as an advantageous alternative. We developed a quantitative real-time PCR for detection of C. pneumoniae. Primers were targeted for the pmp4 gene, and the PCR fragment was detected real-time with a fluorescence resonance energy transfer probe set using a LightCycler instrument. The PCR was used on DNA released from 50 microm sections of paraffin-embedded formalin-fixed lung tissue from experimentally infected mice. Thereby, the number of C. pneumoniae genomes was determined. To our knowledge this is the first time quantification of C. pneumoniae DNA has been attempted on paraffin-embedded formalin-fixed tissue. C. pneumoniae-specific immunohistochemistry (IHC) was done on 5 microm sections adjacent to the sections used in PCR, and the number of inclusions were counted in each section. Good correlation was found when comparing results from PCR and IHC, which is in contrast to many previous studies. 相似文献
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Yuste J Botto M Paton JC Holden DW Brown JS 《Journal of immunology (Baltimore, Md. : 1950)》2005,175(3):1813-1819
Streptococcus pneumoniae is a common cause of septicemia in the immunocompetent host. To establish infection, S. pneumoniae has to overcome host innate immune responses, one component of which is the complement system. Using isogenic bacterial mutant strains and complement-deficient immune naive mice, we show that the S. pneumoniae virulence factor pneumolysin prevents complement deposition on S. pneumoniae, mainly through effects on the classical pathway. In addition, using a double pspA-/ply- mutant strain we demonstrate that pneumolysin and the S. pneumoniae surface protein PspA act in concert to affect both classical and alternative complement pathway activity. As a result, the virulence of the pspA-/ply- strain in models of both systemic and pulmonary infection is greatly attenuated in wild-type mice but not complement deficient mice. The sensitivity of the pspA-/ply- strain to complement was exploited to demonstrate that although early innate immunity to S. pneumoniae during pulmonary infection is partially complement-dependent, the main effect of complement is to prevent spread of S. pneumoniae from the lungs to the blood. These data suggest that inhibition of complement deposition on S. pneumoniae by pneumolysin and PspA is essential for S. pneumoniae to successfully cause septicemia. Targeting mechanisms of complement inhibition could be an effective therapeutic strategy for patients with septicemia due to S. pneumoniae or other bacterial pathogens. 相似文献
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Primosome protein PriB is a single-stranded DNA-binding protein that serves as an accessory factor for PriA helicase-catalyzed origin-independent reinitiation of DNA replication in bacteria. A recent report describes the identification of a novel PriB protein in Klebsiella pneumoniae that is significantly shorter than most sequenced PriB homologs. The K. pneumoniae PriB protein is proposed to comprise 55 amino acid residues, in contrast to E. coli PriB which comprises 104 amino acid residues and has a length that is typical of most sequenced PriB homologs. Here, we report results of a sequence analysis that suggests that the priB gene of K. pneumoniae encodes a 104-amino acid PriB protein, akin to its E. coli counterpart. Furthermore, we have cloned the K. pneumoniae priB gene and purified the 104-amino acid K. pneumoniae PriB protein. Gel filtration experiments reveal that the K. pneumoniae PriB protein is a dimer, and equilibrium DNA binding experiments demonstrate that K. pneumoniae PriB's single-stranded DNA-binding activity is similar to that of E. coli PriB. These results indicate that the PriB homolog of K. pneumoniae is similar in structure and in function to that of E. coli. 相似文献