住院患者多重耐药菌感染临床研究

目的 探讨住院患者多重耐药菌感染情况与病原学特点,为临床制定医院感染控制措施提供参考依据.方法 对住院患者中的多重耐药菌感染及病原特点情况进行统计分析.结果 住院患者多重耐药菌感染发生率为3.5％,主要为革兰阴性菌(71.5％),多重耐药菌居前7位的依次是大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、凝固酶阴性葡萄球菌、肠球菌属、金黄色葡萄球菌等.多重耐药菌感染的患者主要来自于重症监护室、神经外科、呼吸内科等.多重耐药菌对选用的抗生素均有较高的耐药性.结论 多重耐药菌耐药率普遍较高,临床医师应重视病原学检查及药敏监测,合理选择使用抗菌药物.     

呼吸内科病房多重耐药菌分布特点与耐药性分析

【摘要】 目的 分析义乌市中心医院呼吸内科2012年度多重耐药细菌的分布特点及常见抗菌药物耐药率。方法 选取呼吸内科住院患者的临床资料,对多重耐药菌分布及耐药性进行回顾性分析。结果 共分离出257株多重耐药菌,65.4%来源于慢性阻塞性肺疾病患者,其中年龄分布以70~79岁（68例,26.5%）、80~89岁的（116例,45.1%）所占比例最大,257株多重耐药菌中G+菌29株,占11.3%,主要是耐甲氧西林金葡菌(MRSA)和耐万古霉素肠球菌(VRE),G-菌228株,占88.7%,主要为耐碳青霉烯鲍曼不动杆菌、产ESBLs肺炎克雷伯菌和多重耐药铜绿假单胞菌,对常用抗生素耐药率也较高。结论 呼吸内科病房多重耐药菌感染增多,尤其是老年人和合并基础疾病的患者较多,所以严密监测菌株的分布,监测抗菌药物耐药动态,促进合理使用抗菌药物已刻不容缓。     

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。     

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。     

食品动物养殖环境中细菌耐药性研究进展

抗生素耐药性被世界卫生组织认为是21世纪人类面临的最大的公共卫生安全问题之一。近年来,抗生素耐药基因作为一种新型污染物而受到广泛关注。养殖场现已成为耐药基因的一个重要储库,耐药菌及耐药基因随着动物排泄物进入环境,从而加速了耐药基因在环境中的传播。畜禽养殖环境中耐药基因和耐药菌可能经食物链、空气等途径传至人类,给人类健康带来巨大威胁。文中结合最新文献,主要介绍了动物养殖场抗菌药物耐药菌和耐药基因的分布特点、耐药基因的持留和传播扩散、研究方法等方面的研究进展,为食品动物养殖环境的抗菌药物耐药性风险评估提供一定支持。     

老年期精神病患者多重耐药菌感染的危险因素分析

目的了解老年期精神病患者多重耐药菌感染与危险因素的相关性,为临床对老年期精神病患者合理应用抗菌药物及有效控制多重耐药菌感染提供理论依据。方法收集在2012—2014年期间嘉兴市康慈医院接受治疗的年龄在60岁以上的老年期精神病患者体内分离确认的多重耐药菌株共74株,采用SPSS 17.0统计软件做多因素Logistic回归分析,分析老年期精神病患者多重耐药菌感染的相关危险因素。结果老年期精神病患者多重耐药菌感染的单因素分析显示年龄(P=0.010)、住院时间(P=0.002)、基础疾病(P=0.188)、侵入性操作(P=0.000)、抗菌药物使用(P=0.000)、抗精神病药使用(P=0.191)等均为老年期精神病患者多重耐药菌感染的相关因素。多因素Logistic回归分析显示基础疾病和侵入性操作是老年期精神病患者多重耐药菌感染的高危险因素。结论基础疾病和侵入性操作是老年期精神病患者多重耐药菌感染的高危险因素。提示临床严防抗菌药物过度应用,减少侵入性操作,从而避免老年期精神病患者感染菌株中多重耐药菌株的产生。     

耐药微生物和抗生素耐药基因与全健康

因人类的各种活动,耐药微生物和抗生素耐药基因在“人-动物-环境”界面发生跨物种和跨生境的传播。将人类、动物和环境视作有机整体的“全健康”（One Health）理念有望成为解决这种传播的有效策略。抗生素及其代谢活性产物在环境中富集,再经动物及动物制品传播到人,产生耐药微生物并造成耐药基因的传播。本文综述了人-动物-环境界面耐药菌和抗生素耐药基因传播的流动与循环,总结了我国和其他国家应对抗生素耐药性问题的政策,倡导更多的国家和地区将“全健康”理念和方法用于控制抗生素耐药性传播;通过医疗卫生部门、食品药品监督管理部门、农林渔牧部门与教育、财政等多部门合作来应对抗生素耐药性的全球挑战。     

不动杆菌耐药机制的研究现状

不动杆菌（Acinetobacter）是一种毒力较低的条件致病菌,广泛存在于自然界、人体皮肤及黏膜上,以往该菌所引起的感染很少见.近年来随着抗菌药物的临床广泛应用,诱导了大量该菌属耐药株的产生,该菌的临床分离率越来越高,并形成了对单一抗菌药物耐药到多重耐药（multidrug resistant）,由低耐药率到高耐药率的发展,主要导致肺炎、泌尿系感染、脑膜炎等.因此对这些常用抗菌药物的耐药机制的研究以及如何减少耐药株的产生已成为当前该领域较为关注的主题.     

耐药菌感染的噬菌体治疗专利技术

耐药菌,尤其是多重耐药菌的出现和持续进化给人类健康带来了巨大的威胁。在抗生素逐渐失去特效作用的情况下,科学界和医药界又把眼光重新投向了抗菌的天然生物-噬菌体,并在一些研究中证明了噬菌体可以作为新的武器去替代抗生素治疗耐药菌感染。通过对噬菌体治疗及衍生的裂解酶治疗的世界专利申请进行统计及分析,获得了专利发展趋势、申请人分布特点及主要专利申请人等信息,详细分析了噬菌体及裂解酶治疗的主要专利技术路线和研发热点。     

耐药菌感染的噬菌体治疗专利技术

耐药菌,尤其是多重耐药菌的出现和持续进化给人类健康带来了巨大的威胁。在抗生素逐渐失去特效作用的情况下,科学界和医药界又把眼光重新投向了抗菌的天然生物-噬菌体,并在一些研究中证明了噬菌体可以作为新的武器去替代抗生素治疗耐药菌感染。通过对噬菌体治疗及衍生的裂解酶治疗的世界专利申请进行统计及分析,获得了专利发展趋势、申请人分布特点及主要专利申请人等信息,详细分析了噬菌体及裂解酶治疗的主要专利技术路线和研发热点。     

水环境中耐药菌污染与危害研究进展

细菌在抗菌药选择性压力下产生耐药性并可传代,通过质粒和整合子等可移动基因元件将耐药基因在相同或不同种属中广泛传播,导致细菌多重耐药,并可通过多种途径进入水体,水环境日益成为庞大的耐药基因库,为致病菌及条件致病菌提供获得大量耐药基因的机会,若多重耐药菌再次侵入人体,可能引发严重的公共卫生问题。     

Characteristics of ARG-carrying plasmidome in the cultivable microbial community from wastewater treatment system under high oxytetracycline concentration

Studies on antibiotic production wastewater have shown that even a single antibiotic can select for multidrug resistant bacteria in aquatic environments. It is speculated that plasmids are an important mechanism of multidrug resistance (MDR) under high concentrations of antibiotics. Herein, two metagenomic libraries were constructed with plasmid DNA extracted from cultivable microbial communities in a biological wastewater treatment reactor supplemented with 0 (CONTROL) or 25 mg/L of oxytetracycline (OTC-25). The OTC-25 plasmidome reads were assigned to 72 antibiotic resistance genes (ARGs) conferring resistance to 13 types of antibiotics. Dominant ARGs, encoding resistance to tetracycline, aminoglycoside, sulfonamide, and multidrug resistance genes, were enriched in the plasmidome under 25 mg/L of oxytetracycline. Furthermore, 17 contiguous multiple-ARG carrying contigs (carrying ≥ 2 ARGs) were discovered in the OTC-25 plasmidome, whereas only nine were found in the CONTROL. Mapping of the OTC-25 plasmidome reads to completely sequenced plasmids revealed that the conjugative IncU resistance plasmid pFBAOT6 of Aeromonas caviae, carrying multidrug resistance transporter (pecM), tetracycline resistance genes (tetA, tetR), and transposase genes, might be a potential prevalent resistant plasmid in the OTC-25 plasmidome. Additionally, two novel resistant plasmids (containing contig C301682 carrying multidrug resistant operon mexCD-oprJ and contig C301632 carrying the tet36 and transposases genes) might also be potential prevalent resistant plasmids in the OTC-25 plasmidome. This study will be helpful to better understand the role of plasmids in the development of MDR in water environments under high antibiotic concentrations.

     

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。     

污水处理厂生物气溶胶抗生素抗性污染特征、来源及潜在风险

污水处理厂是抗生素抗性基因（antibiotic resistance genes,ARGs）和抗生素抗性细菌（antibiotic resistant bacteria,ARB）重要的源和汇,生物气溶胶是ARGs和ARB自污水处理厂向周边环境释放的关键载体。目前缺乏对污水处理厂生物气溶胶抗生素抗性污染特征、来源及潜在风险的系统性总结。本文从采样方法、检测方法、逸散特征、来源、潜在危害和风险评估等方面对污水处理厂抗生素抗性污染研究现状进行综述。惯性采样法和过滤法是常用的污水处理厂抗生素抗性生物气溶胶主要采集方法,而宏基因组测序、组装和分箱为其ARGs组成、可移动性和宿主提供了有效的检测方法,抗多药类、抗杆菌肽类、抗氨基糖苷类、抗四环素类、抗β-内酰胺类、抗磺胺类、抗大环内酯类和抗糖肽类等抗性基因在污水处理厂PM₁₀、PM_2.5和PM_1.0颗粒物中广泛检出。格栅间、生化反应池和污泥处理单元是污水处理厂PM₁₀、PM_2.5和PM_1.0负载ARGs和ARB的主要释放单元。污水处理厂不同粒径生物气溶胶中致病性ARB的存在增加了抗生素治疗的难度,而污水和污泥对ARGs和ARB的释放起到了重要的源的贡献。本文在研究内容、研究技术和控制策略等方面也提出了相关展望,以期为污水厂生物气溶胶抗生素抗性污染的监测和防护提供参考和借鉴。     

Whole-genome sequencing and gene sharing network analysis powered by machine learning identifies antibiotic resistance sharing between animals,humans and environment in livestock farming

Anthropogenic environments such as those created by intensive farming of livestock, have been proposed to provide ideal selection pressure for the emergence of antimicrobial-resistant Escherichia coli bacteria and antimicrobial resistance genes (ARGs) and spread to humans. Here, we performed a longitudinal study in a large-scale commercial poultry farm in China, collecting E. coli isolates from both farm and slaughterhouse; targeting animals, carcasses, workers and their households and environment. By using whole-genome phylogenetic analysis and network analysis based on single nucleotide polymorphisms (SNPs), we found highly interrelated non-pathogenic and pathogenic E. coli strains with phylogenetic intermixing, and a high prevalence of shared multidrug resistance profiles amongst livestock, human and environment. Through an original data processing pipeline which combines omics, machine learning, gene sharing network and mobile genetic elements analysis, we investigated the resistance to 26 different antimicrobials and identified 361 genes associated to antimicrobial resistance (AMR) phenotypes; 58 of these were known AMR-associated genes and 35 were associated to multidrug resistance. We uncovered an extensive network of genes, correlated to AMR phenotypes, shared among livestock, humans, farm and slaughterhouse environments. We also found several human, livestock and environmental isolates sharing closely related mobile genetic elements carrying ARGs across host species and environments. In a scenario where no consensus exists on how antibiotic use in the livestock may affect antibiotic resistance in the human population, our findings provide novel insights into the broader epidemiology of antimicrobial resistance in livestock farming. Moreover, our original data analysis method has the potential to uncover AMR transmission pathways when applied to the study of other pathogens active in other anthropogenic environments characterised by complex interconnections between host species.     

环境中抗生素抗性基因与I型整合子的研究进展

抗生素抗性基因(Antibiotic resistance genes,ARGs)作为一种新型污染物在不同环境中广泛分布、来源复杂,对生态环境和人类健康造成了很大的潜在风险。同时,Ⅰ型整合子(Int Ⅰ)介导的ARGs水平转移是环境中微生物产生耐药性的重要途径,Ⅰ型整合子整合酶基因(intI1)与ARGs丰度在环境中表现出了较高的正相关性,Int Ⅰ可以作为标记物在一定程度上反映ARGs在环境中的迁移转化规律和人类活动影响程度。本文介绍ARGs与Int Ⅰ在环境中的来源与分布,总结Int Ⅰ介导的ARGs迁移转化机制以及相关研究方法,并展望未来的研究发展趋势。     

Bacterial diversity and the antimicrobial resistome in the southwestern highlands of Saudi Arabia

Soil is a reservoir of microbial diversity and the most supportive habitat for acquiring and transmitting antimicrobial resistance. Resistance transfer usually occurs from animal to soil and vice versa, and it may ultimately appear in clinical pathogens. In this study, the southwestern highlands of Saudi Arabia were studied to assess the bacterial diversity and antimicrobial resistance that could be affected by the continuous development of tourism in the region. Such effects could have a long-lasting impact on the local environment and community. Culture-dependent, quantitative polymerase chain reaction (qPCR), and shotgun sequencing-based metagenomic approaches were used to evaluate the diversity, functional capabilities, and antimicrobial resistance of bacteria isolated from collected soil samples. Bacterial communities in the southwestern highlands were mainly composed of Proteobacteria, Bacteroidetes, and Actinobacteria. A total of 102 antimicrobial resistance genes (ARGs) and variants were identified in the soil microbiota and were mainly associated with multidrug resistance, followed by macrolide, tetracycline, glycopeptide, bacitracin, and beta-lactam antibiotic resistance. The mechanisms of resistance included efflux, antibiotic target alteration, and antibiotic inactivation. qPCR confirmed the detection of 18 clinically important ARGs. In addition, half of the 49 identified isolates were phenotypically resistant to at least one of the 15 antibiotics tested. Overall, ARGs and indicator genes of anthropogenic activities (human-mitochondrial [hmt] gene and integron-integrase [int1]) were found in relatively lower abundance. Along with a high diversity of bacterial communities, variation was observed in the relative abundance of bacterial taxa among sampling sites in the southwestern highlands of Saudi Arabia.     

Chlorine disinfection facilitates natural transformation through ROS-mediated oxidative stress

The bacterial infection that involves antimicrobial resistance is a rising global threat to public health. Chlorine-based water disinfection processes can inactivate antibiotic resistant bacteria. However, at the same time, these processes may cause the release of antibiotic resistance genes into the water as free DNA, and consequently increase the risk to disseminate antibiotic resistance via natural transformation. Presently, little is known about the contribution of residual chlorine affecting the transformation of extracellular antibiotic resistance genes (ARGs). This study investigates whether chloramine and free chlorine promote the transformation of ARGs and how this may occur. We reveal that both chloramine and free chlorine, at practically relevant concentrations, significantly stimulated the transformation of plasmid-encoded ARGs by the recipient Acinetobacter baylyi ADP1, by up to a 10-fold increase. The underlying mechanisms underpinning the increased transformations were revealed. Disinfectant exposure induced a series of cell responses, including increased levels of reactive oxygen species (ROS), bacterial membrane damage, ROS-mediated DNA damage, and increased stress response. These effects thus culminated in the enhanced transformation of ARGs. This promoted transformation was observed when exposing disinfectant-pretreated A. baylyi to free plasmid. In contrast, after pretreating free plasmid with disinfectants, the transformation of ARGs decreased due to the damage of plasmid integrity. These findings provide important insight on the roles of disinfectants affecting the horizontal transfer of ARGs, which could be crucial in the management of antibiotic resistance in our water systems.Subject terms: Antibiotics, Public health     

Research progress on distribution,migration, transformation of antibiotics and antibiotic resistance genes (ARGs) in aquatic environment

Antimicrobial and antibiotics resistance caused by misuse or overuse of antibiotics exposure is a growing and significant threat to global public health. The spread and horizontal transfer of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) by the selective pressure of antibiotics in an aquatic environment is a major public health issue. To develop a better understanding of potential ecological risks die to antibiotics and ARGs, this study mainly summarizes research progress about: (i) the occurrence, concentration, fate, and potential ecological effects of antibiotics and ARGs in various aquatic environments, (ii) the threat, spread, and horizontal gene transfer (HGT) of ARGs, and (iii) the relationship between antibiotics, ARGs, and ARB. Finally, this review also proposes future research direction on antibiotics and ARGs.