质粒介导黏菌素耐药机制研究进展

黏菌素是一种多肽类抗生素,对革兰阴性菌具有较强的抗菌活性。由于其副作用大,一直以来黏菌素在临床中很少被使用。近年来,随着多重耐药菌,特别是耐碳青霉烯类肠杆菌的产生,黏菌素耐药基因mcr的研究逐渐受到重视。过去通常认为,黏菌素耐药性由染色体介导,无法在细菌间水平传播。mcr1基因的发现证明黏菌素耐药性还可能通过质粒介导水平传播。本文将介绍多种黏菌素耐药基因mcr及其流行特征、MCR作用机制和分类特点,为黏菌素的合理使用提供理论支持,以及采取针对性的预防措施。     

多黏菌素的流行状况与耐药机制的研究

近年来,由于革兰阴性菌(Gram-negative bacteria)多药耐药性的增加,严重地威胁着人类的健康。由于可选择的抗菌药物越来越少,感染病医师和临床微生物学家需重新评估多黏菌素的临床应用。多黏菌素是治疗临床碳青霉烯类耐药革兰阴性菌的最后一道抗生素。现结合国内外最新研究报道,对多黏菌素耐药流行状况、耐药机制、耐药基因类型、预防干预措施等方面作一概述。     

耐碳青霉烯类肺炎克雷伯菌对多黏菌素耐药性的研究进展

多黏菌素是目前临床治疗耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)感染为数不多的抗生素.近年来,对多黏菌素耐药的CRKP显著增加,为临床抗感染治疗带来前所未有的挑战.目前,CRKP对多黏菌素耐药的可能机制主要包括表达质粒介导的mcr基因、激活...     

多重耐药阴沟肠杆菌质粒型AmpC酶DHA-1基因的检出

目的测定56株同时耐头孢噻肟、庆大霉素和环丙沙星的阴沟肠杆菌质粒型AmpC酶基因型。方法先后用头孢西丁纸片法、三维试验、等电聚焦及酶抑制试验和微量稀释法进行表型检测。接合试验证实酶基因的转移性。多重聚合酶链反应以及基因测序等方法鉴定质粒型AmpC酶基因型。结果受试的56株细菌中有5株三维试验阳性,其中1株能转移接合,接合子多重聚合酶链反应扩增结果呈阳性,等电点为7．8,基因测序表明和DHA-1型AmpC酶一致。结论我国的多重耐药阴沟肠杆菌已获得质粒型DHA基因,DHA基因可通过转化、接合等方式转移给其他细菌且易于传播,因此应加强监控以防DHA基因在革兰阴性菌中流行。     

超广谱β-内酰胺类抗生素的耐药性与耐药质粒介导

目的：观察超广谱β-内酰胺类抗生素的敏感性与耐药质粒的关系,探讨耐药质粒在细菌之间传递的方式。方法：(1)配制耐药质粒提取试剂;(2)对LB细菌培养液进行耐药质粒的提取与检测;(3)对从12株ESBL细菌中提取的质粒进行质粒转化、质粒接合传递及药敏试验。结果：(1)此12株ESBL细菌中提取的耐药质粒进行电泳显示此质粒较大,约20．0kb。(2)质粒转化后,其转化子对β-内酰胺类抗生素全部耐药,对氨基糖甙类、喹诺酮类和磺胺类全部敏感。质粒结合传递体的耐药谱与以上相同。结论：β-内酰胺类抗生素的敏感性与耐药质粒介导密切相关,耐药质粒能把耐药基因传递给其他细菌,在细菌之间相互传递。     

一养殖场中质粒介导喹诺酮类药物耐药基因qnrS的流行特性

摘要:【目的】研究质粒介导喹诺酮类药物耐药基因qnrS在一养殖场中的流行特点。【方法】分离养殖场不同来源样品中的大肠杆菌菌株,利用美国临床标准委员会(CLSI)推荐的药敏纸片法测定菌株耐药情况,通过质粒接合试验获得qnrS阳性接合子,测定qnrS对喹诺酮类药物最小抑菌浓度(MIC)值的影响及其与其它类抗生素耐药性的相关性,利用脉冲场凝胶电泳分析该场中qnrS阳性菌株遗传进化关系。【结果】环境源菌株qnrS的阳性率为29.2%,显著高于禽源菌株基因检出率(13.4%),新进的雏鸡可迅速从养殖场中获得 qnrS基因并在鸡群中流行。qnrS基因可使接合子对喹诺酮类药物MIC值不同程度升高,并且与其它五类抗生素具有相关性,不同qnrS阳性菌株间遗传关系较远,但也存在同一克隆株的流行。【讨论】qnrS基因主要通过质粒的播散等进行水平传播,同时也存在同一克隆株的流行传播。qnrS基因多样性及其水平传播方式造成了它的广泛流行,加强对耐药基因的监测及研究对减少多重耐药菌株的产生具有重要意义。     

分子模拟在多黏菌素药理机制研究中的应用

多黏菌素是一种膜靶向的脂肽类抗生素,是临床上治疗革兰氏阴性多重耐药菌感染的最后一道防线。通过与脂多糖相互作用,多黏菌素破坏细菌外膜结构并导致细菌死亡。然而,受限于生物化学和结构生物学手段对细胞膜-药物相互作用的表征能力,目前对多黏菌素药理机制的认识还不充分,从而限制了新一代多黏菌素药物的设计和开发。为此,本文总结了近年来利用分子动力学方法对细胞膜系统与多黏菌素相互作用的研究进展,为深入理解多黏菌素药理机制与细胞膜系统的内在联系,加快新型抗生素药物研发提供新思路。     

多重耐药伤寒沙门菌耐药基因的研究

目的 检测多重耐药伤寒沙门菌对抗菌药物的敏感性及其耐药基因定位。方法 随机选取实验室保存的5株耐药菌和1株敏感菌,用纸片扩散法检测对12种抗菌药物的敏感性。用利舍平抑制试验检测菌株是否存在药物外排系统。PCR法检测TEM型β-内酰胺酶基因、aac(6′)-Ⅰb和aac3-Ⅱ型氨基糖苷类修饰酶基因、qacEΔ1-sul1耐消毒剂和磺胺基因、catA和catB氯霉素乙酰基转移酶基因以及cmlA氯霉素外排泵蛋白基因等7种耐药基因。结果 5株多重耐药菌对氨苄西林、哌拉西林、头孢呋辛、头孢西丁、卡那霉素、庆大霉素、复方磺胺甲噁唑及氯霉素等8种抗菌药物全部耐药,对美罗培南、头孢哌酮、头孢吡肟全部敏感;对头孢噻吩中度敏感。1株无质粒pRST98的菌株对上述药物全部敏感。利舍平抑制试验均为阴性。4株耐药菌TEM型β-内酰胺酶基因检测为阳性。全部耐药菌株aac3-Ⅱ、qacEΔ1-sul1、catA基因均为阳性,而aac(6′)-Ⅰb、catB和cmlA基因均为阴性。 结论 多重耐药伤寒沙门菌质粒pRST98上同时存在多种耐药基因, 是导致菌株同时对多种结构各异的抗生素耐药的原因。     

质粒介导的喹诺酮耐药基因qnr的分类、耐药机制及其在国内的流行状况北大核心CSCD

喹诺酮类抗菌药物从早期主要用于治疗尿道感染发展到后来治疗肠道感染和呼吸道感染,目前已在临床、畜牧业和水产业中广泛使用,细菌对其耐药性也逐渐呈蔓延趋势,耐药机制日趋复杂。喹诺酮类耐药机制主要分为染色体介导的耐药和质粒介导的耐药,后者对细菌耐药性的广泛传播起着重要作用。1998年首次报道了质粒介导的喹诺酮类耐药机制,即质粒上qnr基因介导的细菌对氟喹诺酮耐药机制,qnr基因可在不同细菌中迅速水平传播,引发的感染不易控制,使得院内感染大范围的流行。此外,qnr基因通常与β-内酰胺类耐药基因相关或存在于复杂整合子中与其它多重耐药基因共同整合,缩小了临床医生治疗相关细菌感染时选药或联合用药的空间,给我们带来了严峻的挑战。本文就qnr基因的发现历史、耐药机理及在国内的流行状况做了详细概述。     

淋球菌耐药性与耐药质粒的研究

为了解湛江地区淋球菌耐药现状及耐药质粒的分布,并初步探讨其相互关系,对１９９８￣１９９９年广东省湛江地区健康鉴定出的９８株淋球菌流行株,应用纸片扩散法测定细胞对１０种抗生素的敏感性,并采用碱裂解法进行质粒抽提,分析耐药质粒的分布情况,选取ＮＧ４、ＮＧ３１、ＮＧ４３、ＮＧ７０进行细菌的接合试验,以观察耐药质粒能否通过接合进行传递以及传递后受体菌耐药性的变化。结果显示６．１２％菌株对全部抗生素敏感,４８．９６％的菌株对３种及３种以上的抗生素耐药;共检出四种不同分子量的质闰,７．４ｋｂ和４．２ｋｂ质粒检出率较高,分别为５９．１６％和６７．３２％,质粒谱型１２种,以７．４ｋｇ＋４．２ｋｇ和３９．５ｋｇ＋７．４ｋｇ＋４．２ｋｇ为主,占３８．７６％。在细菌的接合传递试验中,ＮＧ４３可通过接合传递将其耐药性传递给淋球菌及大肠     

Global distribution of plasmid-mediated colistin resistance mcr gene in Salmonella: A systematic review

This systematic review focuses on obtaining the most relevant information from multiple studies that detected a mobilized colistin resistance mcr gene in Salmonella for a better comprehension of its global distribution. A group of strategic and systematic keywords were combined to retrieve research data on the detection frequency of the mcr gene globally from four database platforms (Google Scholar, Science Direct, PubMed and Scielo). Forty-eight studies attended all the eligibility criteria and were selected. China was the country with the highest frequency of Salmonella strains with the mcr gene, and Europe exhibited a wide diversity of countries with positive mcr strains. In addition, animals and humans carried the highest frequency of positive strains for the mcr gene. Salmonella Typhimurium was the most frequent serovar carrying the mcr gene. Apparently, colistin overuse in animal husbandry has increased the selective pressure of antimicrobial resistance, resulting in the emergence of a plasmid-mediated colistin resistance mcr gene in China. The mcr-positive Salmonella strains are recently predominant worldwide, which is probably due to the capacity of this gene to be swiftly horizontally transmissible. The transmission ability of mcr-positive Salmonella strains to humans through the consumption of contaminated animal-based food is a public health concern.     

Association of the colistin resistance gene mcr-1 with faecal pollution in water environments in Hanoi,Vietnam

Colistin is one of the antibiotics of last resort for human health. However, the dissemination of the plasmid-mediated colistin resistance gene mcr-1 is of great concern globally. In the One Health framework, the environment is an important component for managing antimicrobial resistance. However, little information is available concerning the prevalence of mcr-1 in water environments. We aimed to reveal the prevalence of mcr-1 in different water environments in Hanoi, Vietnam. Quantitative PCR was applied to detect mcr-1 in four urban drainages receiving untreated domestic wastewater, three rivers, five lakes and two groundwater samples. Urban drainages contained higher concentrations of mcr-1, suggesting that urban residents carry the gene. The class 1 integron-integrase gene was identified as a good surrogate of antibiotic resistance genes including mcr-1. A significant correlation was found between the levels of mcr-1 and the human-specific cross-assembly phage, which is an indicator of human faecal pollution. These results indicated that the primary source of mcr-1 in urban water environments is human faeces, which is consistent with the fact that most domestic wastewater is untreated in Hanoi. The control of untreated wastewater is critical for alleviating the spread of mcr-1 in water environments in Vietnam.     

Screening of mcr-1 Among Gram-Negative Bacteria from Different Clinical Samples from ICU Patients in Alexandria,Egypt: One-Year Study

Antimicrobial resistance represents a global dilemma. Our present study aimed to investigate the presence of mcr-1 among different Gram-negative bacteria including Enterobacteriaceae (except intrinsically resistant to colistin) and Pseudomonas aeruginosa. Gram-negative bacterial isolates were collected from different ICUs in several Alexandria hospitals from June 2019 to June 2020. The identification of these Gram-negative isolates was made using the VITEK-2^® system (BioMérieux, France). SYBR Green-based PCR was used to screen for the presence of mcr-1 using a positive control that we amplified and sequenced earlier in our pilot study. All isolates were screened for the presence of mcr-1 regardless of their colistin susceptibility. Isolates that harbored mcr-1 were tested for colistin susceptibility and for the presence of some beta-lactamase genes. Klebsiella pneumoniae isolates harboring mcr-1 were capsule typed using the wzi sequence analysis. Four hundred eighty isolates were included in this study. Only six isolates harbored mcr-1.1. Of these, four were resistant to colistin, while two (K. pneumoniae and P. aeruginosa) were susceptible to colistin. Five of the six isolates were resistant to carbapenems. They harbored bla_OXA-48, and three of them co-harbored bla_NDM-1. K-58 was the most often found among our K. pneumoniae harboring mcr-1.1. To our knowledge, this is the first time to report colistin susceptible P. aeruginosa and K. pneumoniae harboring the mcr-1.1 gene in Egypt. Further studies are needed to investigate the presence of the mcr genes among colistin susceptible isolates to shed more light on its significance as a potential threat. Open in a separate window     

Comparison of disc diffusion, Etest and agar dilution for susceptibility testing of colistin against Enterobacteriaceae

Aims: In this study, we compared different methods of colistin susceptibility testing, disc diffusion, agar dilution and Etest using a set of Enterobacteriaceae isolates that included colistin‐resistant strains. Methods and results: Susceptibility of 200 clinical isolates of Enterobacteriaceae to colistin was tested to compare agar dilution (reference method), disc diffusion (50 and 10 μg) and Etest. MICs (minimum inhibitory concentrations) were interpreted using the criteria established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Colistin exhibited excellent activity against Escherichia coli and E. cloacae (MIC₉₀ = 0·5 mg l^?1). In contrast, colistin was less active against Klebsiella pneumoniae (MIC₉₀ = 16 mg l^?1). Resistance rates varied from 0% in E. coli to 1·8% in E. cloacae and 13% in K. pneumoniae. High rates of very major errors were observed in the disc diffusion test using either the criteria of the Comité de l’antibiogramme de la Société Française de Microbiologie (CA‐SFM) or the criteria of the Clinical and Laboratory Standards Institute (CLSI), respectively, 3·5 and 2·5%. When the criteria of Gales et al. were applied, the number of very major errors was reduced to one (0·5%). The Etest showed good concordance with agar dilution method. Conclusion: Disc susceptibility testing methods are unreliable on detecting colistin resistance. MIC should be determined to confirm the susceptibility results by disc diffusion. Significance and Impact of the study: We recommend the determination of MIC by Etest for all multidrug‐resistant Enterobacteriaceae when colistin is required for the treatment.     

LXA-1: a new plasmid-mediated β-lactamase giving low-level resistance

Abstract LXA-1, a novel plasmid-mediated β-lactamase, was observed in clinical isolates of Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter freundii and Enterobacter cloacae . All the strains additionally produced TEM-1 β-lactamase. LXA-1 had an M _r of 24 000 and a pI of 6.7. It hydrolysed benzyl-penicillin, ampicillin, carbenicillin and first generation cephalosporins, but not methicillin, oxacillin or cefotaxime. Clavulanate and cloxacillin were inhibitors. Studies of one of the E. cloacae isolates showed that LXA-1 was encoded by a 41-MDa IncFII plasmid distinct from that encoding TEM-1 enzyme in the strain. Transconjugants which acquired LXA-1 production, but not TEM-1, exhibited only low-level resistance to substrate β-lactams.     

Extended-spectrum beta-lactamase-producing Escherichia coli harbouring sul and mcr-1 genes isolates from fish gut contents in the Mekong Delta,Vietnam

This study investigated the existence of sulfonamides and colistin resistance genes among extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli recovered from fish gut in Vietnam and evaluated the susceptibility patterns of the ESBL-producing E. coli to relevant antimicrobials. A total of 88 ESBL-producing E. coli isolates were analysed for the presence of the ESBLs, sul (1, 2, 3) and mcr (1–3) genes by PCR. Antimicrobial resistance phenotypes of isolates were determined by disc diffusion. Results showed that: (i) A high prevalence of 94·3% of sulfonamide resistance was observed in 88 isolates. Moreover, the existence of 2·3% of ESBL-producing E. coli harbouring mcr-1 gene were detected; (ii) The phylogenetic types A and B1 were most frequent, and the bla_CTX-M group1 and bla_TEM genes encoding ESBL were detected in 47·7% of the isolates; (iii) ESBL-producing E. coli harbouring mcr-1 gene exhibited resistance to 11 antibiotics. The existence of mcr-1 and sul1,2,3 genes and the extremely high level of multiple drug resistance in all ESBL-producing E. coli isolates obtained from sampled fish in Vietnam is a major concern. Therefore, it is imperative to monitor ESBL-producing E. coli in the river waters of Vietnam.     

Induced colistin resistance as an identifying marker for Aeromonas phenospecies groups

AIMS: To investigate the taxonomic interest of colistin resistance as an identifying marker for Aeromonas phenospecies groups. METHODS AND RESULTS: Colistin resistance was investigated in 387 Aeromonas isolates identified at species level using a 14-test format protocol with miniaturized tests combined with determination of urocanic acid utilization whenever necessary. Colistin resistance, determined by the disc diffusion method, was unreliable when compared with minimum inhibitory concentration (MIC) determination. In some strains, the MIC values and resistance rates of colistin could be increased after overnight induction with a 50- microg colistin disc in 20 ml of Mueller-Hinton broth (2.5 mg l(-1)). Colistin-induced resistance level was raised to 85.8% in the Aeromonas hydrophila complex, 2.1% in the A. caviae complex and 2.5% in the A. veronii complex except for A. jandaei (100% colistin resistant). This new marker allowed the identification of 96.2 and 93.6% of Aeromonas isolates to phenospecies and species level, respectively. CONCLUSIONS: Colistin-induced colistin resistance is a new phenotypic marker for Aeromonas isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: With the present protocol, colistin resistance determination may improve the identification of Aeromonas isolates to phenogroup level, when results obtained by conventional biochemical methods are ambiguous.     

Class 1 and class 2 integrons and plasmid-mediated antibiotic resistance in coliforms isolated from ten rivers in northern Turkey

We aimed to determine the molecular mechanisms of antibiotic resistance in coliforms isolated from ten rivers in northern region of Turkey. A total of 183 isolates were tested for antimicrobial susceptibility by disk diffusion and agar dilution methods. Resistance to ampicillin, streptomycin, trimethoprim, tetracycline, and chloramphenicol was detected in 58%, 51.9%, 24%, 28.4%, and 12.5%, respectively. Twelve (6.5%) phylogenetically distant organisms were detected to harbor self-transmissible plasmids ranging 52 to >147 kb in sizes. Resistances to ampicillin, tetracycline, trimethoprim, streptomycin, and nalidixic acid were commonly transferable traits. Transferable nalidixic acid-resistant strains harbored qnrS gene, which was the first report of plasmid-mediated quinolone resistance in bacteria of environmental origin in Turkey. Fourteen and five coliforms harbored class 1 and class 2 integrons, respectively, and some of them were located on transferable plasmids. Sequence analyses of variable regions of the class 1 and 2 integrons harbored various gene cassettes, dfrA1, dfr2d, dfrA7, dfrA16, dfrA17, aadA1, aadA5, bla _oxA-30, and sat1. A gene cassette array, dfrA16 has been demonstrated for the first time in a Citrobacter koseri isolate. Class 1 and class 2-bearing strains were clustered in different groups by BOX-PCR fingerprinting. Rivers in the northern Turkey may act as receptacle for the multi-drug resistant enterobacteria and can serve as reservoirs of the antimicrobial resistance determinants in the environment. The actual risk to public health is the transfer of resistance genes from the environmental bacteria to human pathogens. This study was presented in part at the 2^nd World Conference on Magic Bullets, held October 3–5, 2008 in Nurnberg, Germany.