阴沟肠杆菌耐碳青霉烯类抗生素的耐药机制研究进展

阴沟肠杆菌是肠杆菌科中常见的院内感染细菌,碳青霉烯类抗生素由于其抗菌谱广、抗菌力强,成为治疗产ESBLs和AmpC酶革兰阴性杆菌感染的有效抗菌药物.但随着碳青霉烯类抗生素的广泛应用,临床上出现很多耐碳青霉烯类抗生素的阴沟肠杆菌(carbapenem-resistant Enterobacter cloacae,CREL),本研究就其耐药机制,从产碳青霉烯酶和非产碳青霉烯酶两方面做一综述.     

肠杆菌科细菌碳青霉烯酶基因的检测

目的了解余姚地区耐碳青霉烯类药物肠杆菌科细菌的耐药情况和碳青霉烯酶耐药基因类型。方法收集2014年3月至12月耐亚胺培南和厄他培南的肠杆菌科细菌18株,进行Hodge试验确认。对于阳性试验菌株采用PCR法检测bla_(KPC)、bla_(NDM-1)、bla_(MH)、bla_(GES)、bla_(SME)、bla_(NmcA)和bla_(SHV-38)七种基因。结果 18株耐碳青霉烯类肠杆菌科细菌经改良Hodge试验确认阳性11株,占61.1%。经PCR检测显示11株均携带有bla_(KPC)基因,其中肺炎克雷伯菌6株,大肠埃希菌3株,阴沟肠杆菌2株。结论余姚地区耐碳青霉烯类药物肠杆菌科细菌的耐药机制主要是bla_(KPC)型碳青霉烯酶。     

肠杆菌科细菌产金属β-内酰胺酶的研究进展

肠杆菌科细菌是社区获得性感染和院内感染的重要病原菌,近年来由于抗生素的大量、不合理使用,导致临床肠杆菌科细菌耐碳青霉烯类抗生素情况日趋严重,其中产金属β-内酰胺酶是导致细菌耐药的主要机制之一.本研究就对碳青霉烯类抗生素耐药的肠杆菌科细菌产生的金属β-内酰胺酶的研究进展作一综述.     

宁波地区肠杆菌科细菌碳青霉烯酶基因的检测研究

目的对宁波地区耐碳青霉烯类肠杆菌科细菌的耐药情况和碳青霉烯酶耐药基因进行研究了解。方法收集2010年1月至11月耐亚胺培南(IPM)、美罗培南(MEM)或厄他培南(ETP)的肠杆菌科菌株进行Hodge试验确认,对于阳性试验菌株PCR同时检测blaKPC、blaNDM-1、blaIMI-1、blaGES、blaSME、blaNmcA和blaSHV-387种基因。结果共收集到肠杆菌科细菌256株,其中耐碳青霉烯类肠杆菌科细菌16株,占6.1%;采用改良Hodge试验确认阳性10株,占62.5%株。PCR检测显示10株均携带有blaKPC,其中肺炎克雷伯菌6株,产气肠杆菌2株,阴沟肠杆菌2株。结论宁波地区产blaKPC型碳青霉烯酶是肠杆菌科细菌耐碳青霉烯类药物的关键因素,其编码基因位于可转移质粒进行传播使得目前的耐药情况越来越严峻。     

2008-2011年肠杆菌科细菌耐药性变迁及对碳青霉烯类抗生素的耐药机制

目的 研究临床分离的肠杆菌科细菌的耐药性变迁和对碳青霉烯类药物不敏感的肠杆菌科细菌(CNSE)的耐药机制,为抗感染治疗提供依据.方法 应用VITEK-2型全自动微生物检测系统对细菌进行鉴定及药敏试验,用PCR法检测A、B、D类碳青霉烯酶基因和esbls基因,并用核酸测序法进行验证.结果 2008-2011年共分离肠杆菌科细菌4154株,四年间对碳青霉烯类药物的耐药率并未显著升高(P＞0.05).对于CNSE而言,氨基糖苷类抗生素特别是阿米卡星的敏感率最高,在90％以上.从338株CNSE中随机挑选出182株进行耐药基因的检测,esbls基因tem、ctx-M、shy和碳青霉烯酶基因kpc、imp的阳性率分别为36.8％、31.9％、19.8％、2.2％和3.3％.kpc和imp主要在肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌中检出,未检出其他碳青霉烯酶耐药基因,包括ndm-1基因.结论 肠杆菌科细菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦仍保持高度敏感.CNSE对碳青霉烯类药物敏感性降低是多种耐药机制共同作用的结果,ndm-1不是导致肠杆菌科细菌对碳青霉烯类药物敏感性降低的原因.     

碳青霉烯酶基因型的研究进展

碳青霉烯类抗菌药物具有广泛的抗菌活性,是治疗革兰阴性杆菌感染的一线药物。随着应用的增加,耐药性的问题日益严重。碳青霉烯酶是目前发现肠杆菌科细菌对碳青霉烯类抗菌药物耐药的主要机制。准确快速检测这些耐药基因是控制其传播的关键。本研究对碳青霉烯酶基因型的研究进展进行综述。     

肠杆菌科细菌耐碳青霉烯类抗菌药物耐药机制的研究进展

碳青霉烯类药物由于其良好的细胞通透性及高度的酶稳定性,是治疗产超广谱β-内酰胺酶(ESBLs)和AmpC酶革兰阴性杆菌感染的有效抗菌药物,对肠杆菌科细菌有非常强的抗菌活性,但随着临床的广泛应用,临床已出现了对其耐药的肠杆菌科细菌,且不断有新的耐药基因被发现。本文就其耐药机制、检测方法、常用抗菌药物的选择及预防措施等问题作一综述。     

革兰阴性细菌对碳青霉烯类抗生素耐药机制的研究进展

目的 目前革兰阴性细菌对碳青霉烯类抗生素的耐药形势日趋严峻,耐药率日益增高,菌种类型也从非发酵菌扩大到肠杆菌科细菌.其耐药机制主要以产碳青霉烯酶为主,辅以细菌外膜蛋白通透性降低、主动外排泵功能亢进和药物作用靶点青霉素结合蛋白改变等多种耐药机制协同作用.耐药基因众多,新耐药基因层出不穷,耐药机制复杂,给临床和科研带来了极大挑战.本文主要就革兰阴性细菌耐碳青霉烯类抗生素的机制及耐药菌的流行情况做一简要综述.     

肠杆菌科细菌碳青霉烯酶基因的检测

摘要：目的 了解余姚地区耐碳青霉烯类药物肠杆菌科细菌的耐药情况和碳青霉烯酶耐药基因类型。方法 收集2014年3月至12月耐亚胺培南和厄他培南的肠杆菌科细菌18株,进行Hodge试验确认。对于阳性试验菌株采用PCR法检测blaKPC、blaNDM-1、blaMH、blaGES、blaSME、blaNmcA和blaSHV-387种基因。结果 18株耐碳青霉烯类肠杆菌科细菌经改良Hodge试验确认阳性11株,占61.1%。经PCR检测显示11株均携带有blaKPC基因,其中肺炎克雷伯菌6株,大肠埃希菌3株,阴沟肠杆菌2株。结论 余姚地区耐碳青霉烯类药物肠杆菌科细菌的耐药机制主要是blaKPC型碳青霉烯酶。     

MHT和mCIM试验检测肠杆菌科金属碳青霉烯酶效能的评价

目的 探讨改良Hodge试验（MHT）及改良碳青霉烯灭活试验（mCIM）检测肠杆菌科细菌金属碳青霉烯酶的应用价值。方法 VITEK 2 Compact全自动细菌鉴定及药敏系统进行细菌鉴定和药敏试验,筛选2015-2017年非重复临床分离的碳青霉烯类耐药的肠杆菌科细菌,MHT及mCIM进行产碳青霉烯酶表型确证试验,PCR检测常见的金属碳青霉烯酶IMP-4、IMP-8、VIM-1、VIM-2、NDM基因。比较MHT及mCIM对肠杆菌科金属碳青霉烯酶的检测效能。结果 本实验共收集40株临床分离菌株,MHT阳性36株,阳性率90.0%。mCIM阳性39株,阳性率为97.5%。PCR产物测序Blast比对证实4株为产IMP酶菌株,5株产NDM型菌株,未检测到VIM基因。MHT试验检测IMP酶的灵敏度、特异性、阳性预测值、阴性预测值分别为100.0%、11.1%、11.1%、100.0%,MHT检测NDM酶分别为40.0%、2.9%、5.6%、25.0%。mCIM检测IMP酶的灵敏度、特异性、阳性预测值、阴性预测值分别100.0%、2.8%、10.3%、100.0%,mCIM检测NDM型分别为100.0%、2.9%、12.8%、100.0%。结论 MHT及mCIM检测肠杆菌科细菌产金属碳青霉烯酶具有良好的灵敏度,但特异性偏低,应结合分子生物学方法进行检测,为感染控制提供保障。     

Carbapenem resistance in Enterobacteriaceae: here is the storm!

The current worldwide emergence of resistance to the powerful antibiotic carbapenem in Enterobacteriaceae constitutes an important growing public health threat. Sporadic outbreaks or endemic situations with enterobacterial isolates not susceptible to carbapenems are now reported not only in hospital settings but also in the community. Acquired class A (KPC), class B (IMP, VIM, NDM), or class D (OXA-48, OXA-181) carbapenemases, are the most important determinants sustaining resistance to carbapenems. The corresponding genes are mostly plasmid-located and associated with various mobile genetic structures (insertion sequences, integrons, transposons), further enhancing their spread. This review summarizes the current knowledge on carbapenem resistance in Enterobacteriaceae, including activity, distribution, clinical impact, and possible novel antibiotic pathways.     

Crystal structure of KPC-2: insights into carbapenemase activity in class A beta-lactamases

Beta-lactamases inactivate beta-lactam antibiotics and are a major cause of antibiotic resistance. The recent outbreaks of Klebsiella pneumoniae carbapenem resistant (KPC) infections mediated by KPC type beta-lactamases are creating a serious threat to our "last resort" antibiotics, the carbapenems. KPC beta-lactamases are serine carbapenemases and are a subclass of class A beta-lactamases that have evolved to efficiently hydrolyze carbapenems and cephamycins which contain substitutions at the alpha-position proximal to the carbonyl group that normally render these beta-lactams resistant to hydrolysis. To investigate the molecular basis of this carbapenemase activity, we have determined the structure of KPC-2 at 1.85 A resolution. The active site of KPC-2 reveals the presence of a bicine buffer molecule which interacts via its carboxyl group with conserved active site residues S130, K234, T235, and T237; these likely resemble the interactions the beta-lactam carboxyl moiety makes in the Michaelis-Menten complex. Comparison of the KPC-2 structure with non-carbapenemases and previously determined NMC-A and SME-1 carbapenemase structures shows several active site alterations that are unique among carbapenemases. An outward shift of the catalytic S70 residue renders the active sites of the carbapenemases more shallow, likely allowing easier access of the bulkier substrates. Further space for the alpha-substituents is potentially provided by shifts in N132 and N170 in addition to concerted movements in the postulated carboxyl binding pocket that might allow the substrates to bind at a slightly different angle to accommodate these alpha-substituents. The structure of KPC-2 provides key insights into the carbapenemase activity of emerging class A beta-lactamases.     

Emergence of Carbapenemase Producing Klebsiella Pneumonia and Spread of KPC-2 and KPC-17 in Taiwan: A Nationwide Study from 2011 to 2013

The emergence of carbapenemase-producing Klebsiella pneumoniae (CPKP) has become a great concern worldwide. In this study, 994 non-duplicate, carbapenem non-susceptible Klebsiella pneumonia isolates were collected in Taiwan from 2011 to 2013 for detection of the carbapenemase genes, assessment of antimicrobial susceptibility and molecular epidemiology studies. Of these 994 isolates, 183 (18.4%) had carbapenemase genes: 157 (15.8%) KPC (145 KPC-2 and 12 KPC-17), 16 (1.6%) IMP-8, 9 (0.9%) VIM-1, and 1 (0.1%) NDM-1. KPC had the highest prevalence rate among the carbapenemases and represented a major epidemic clone circulating in Taiwan. The ST512 and ST258 KPC-2 KPs were first identified in Taiwan and were grouped into a small cluster in the PFGE profile. In addition, the genetic structure encompassing the bla _KPC gene of the ST512 and ST258 isolates showed a different pattern from that of other KPC isolates. ST11 may be a major sequence type circulating in Taiwan, although a specific minor clone has begun to be observed. This is the first report of ST258 and ST512 KPC-2 KP isolates in Taiwan, whether ST258 and ST512 will become the next endemic problems in Taiwan should be closely monitored.     

Role of the UBL-UBA protein KPC2 in degradation of p27 at G1 phase of the cell cycle

KPC2 (Kip1 ubiquitylation-promoting complex 2) together with KPC1 forms the ubiquitin ligase KPC, which regulates degradation of the cyclin-dependent kinase inhibitor p27 at the G(1) phase of the cell cycle. KPC2 contains a ubiquitin-like (UBL) domain, two ubiquitin-associated (UBA) domains, and a heat shock chaperonin-binding (STI1) domain. We now show that KPC2 interacts with KPC1 through its UBL domain, with the 26S proteasome through its UBL and NH(2)-terminal UBA domains, and with polyubiquitylated proteins through its UBA domains. The association of KPC2 with KPC1 was found to stabilize KPC1 in a manner dependent on the STI1 domain of KPC2. KPC2 mutants that lacked either the NH(2)-terminal or the COOH-terminal UBA domain supported the polyubiquitylation of p27 in vitro, whereas a KPC2 derivative lacking the STI1 domain was greatly impaired in this regard. Depletion of KPC2 by RNA interference resulted in inhibition of p27 degradation at the G(1) phase, and introduction of KPC2 derivatives into the KPC2-depleted cells revealed that the NH(2)-terminal UBA domain of KPC2 is essential for p27 degradation. These observations suggest that KPC2 cooperatively regulates p27 degradation with KPC1 and that the STI1 domain as well as the UBL and UBA domains of KPC2 are indispensable for its function.     

Molecular dissection of the interaction between p27 and Kip1 ubiquitylation-promoting complex, the ubiquitin ligase that regulates proteolysis of p27 in G1 phase

The cyclin-dependent kinase (CDK) inhibitor p27 is degraded at the G(0)-G(1) transition of the cell cycle by the ubiquitin-proteasome pathway in a Skp2-independent manner. We recently identified a novel ubiquitin ligase, KPC (Kip1 ubiquitylation-promoting complex), consisting of KPC1 and KPC2, which regulates the ubiquitin-dependent degradation of p27 at G(1) phase. We have now investigated the structural requirements for the interactions of KPC1 with KPC2 and p27. The NH(2)-terminal region of KPC1 was found to be responsible for binding to KPC2 and to p27. KPC1 mutants that lack this region failed to mediate polyubiquitylation of p27 in vitro and expression of one such mutant delayed p27 degradation in vivo. We also generated a series of deletion mutants of p27 and found that KPC failed to polyubiquitylate a p27 mutant that lacks the CDK inhibitory domain. Interestingly, the cyclin E.CDK2 complex prevented both the interaction of KPC with p27 as well as KPC-mediated polyubiquitylation of p27. A complex of cyclin E with a kinase-negative mutant of CDK2 also exhibited these inhibitory effects, suggesting that cyclin E.CDK2 competes with KPC1 for access to the CDK inhibitory domain of p27. These results suggest that free p27 is recognized by the NH(2)-terminal region of KPC1, which also associates with KPC2, and that p27 is then polyubiquitylated by the COOH-terminal RING-finger domain of KPC1.     

A genetic screen in Drosophila reveals an unexpected role for the KIP1 ubiquitination-promoting complex in male fertility

A unifying feature of polycystin-2 channels is their localization to both primary and motile cilia/flagella. In Drosophila melanogaster, the fly polycystin-2 homologue, Amo, is an ER protein early in sperm development but the protein must ultimately cluster at the flagellar tip in mature sperm to be fully functional. Male flies lacking appropriate Amo localization are sterile due to abnormal sperm motility and failure of sperm storage. We performed a forward genetic screen to identify additional proteins that mediate ciliary trafficking of Amo. Here we report that Drosophila homologues of KPC1 and KPC2, which comprise the mammalian KIP1 ubiquitination-promoting complex (KPC), form a conserved unit that is required for the sperm tail tip localization of Amo. Male flies lacking either KPC1 or KPC2 phenocopy amo mutants and are sterile due to a failure of sperm storage. KPC is a heterodimer composed of KPC1, an E3 ligase, and KPC2 (or UBAC1), an adaptor protein. Like their mammalian counterparts Drosophila KPC1 and KPC2 physically interact and they stabilize one another at the protein level. In flies, KPC2 is monoubiquitinated and phosphorylated and this modified form of the protein is located in mature sperm. Neither KPC1 nor KPC2 directly interact with Amo but they are detected in proximity to Amo at the tip of the sperm flagellum. In summary we have identified a new complex that is involved in male fertility in Drosophila melanogaster.     

First detection of OXA-24 carbapenemase-producing Acinetobacter baumannii isolates in Bulgaria

This report describes the first identification of OXA-24 carbapenemase-producing Acinetobacter baumannii isolates from Bulgaria. According to national surveillance data A. baumannii along with Pseudomonas aeruginosa are the most troublesome microorganisms in hospital environment with high rates of acquired carbapenem resistance. In the present study real-time multiplex PCR was performed to identify the most common carbapenemase genes in 15 non-duplicate carbapenem-resistant A. baumannii isolates collected in 2012. The results showed lack of KPC, GES, VIM, IMP-type enzymes. Four A. baumannii isolates tested positive by PCR for the acquired OXA-24 together with the intrinsic OXA-51 carbapenemase. OXA-24 and OXA-23 were determined as co-existent in one isolate. Two isolates were identified with OXA-23 in addition to the OXA-51 carbapenemase.     

KPC1 expression and essential role after acute spinal cord injury in adult rat

KPC1 (Kip1 ubiquitylation-promoting complex 1) is the catalytic subunit of the ubiquitin ligase KPC, which regulates the degradation of the cyclin-dependent kinase inhibitor p27^kip1 at the G1 phase of the cell cycle. To elucidate the expression and role of KPC1 in nervous system lesion and repair, we performed an acute spinal cord contusion injury (SCI) model in adult rats. Western blot analysis showed a significant up-regulation of KPC1 and a concomitant down-regulation of p27^kip1 following spinal injury. Immunohistochemistry and immunofluorescence revealed wide expression of KPC1 in the spinal cord, including expression in neurons and astrocytes. After injury, KPC1 expression was increased predominantly in astrocytes, which highly expressed PCNA, a marker for proliferating cells. Co-immunoprecipitation demonstrated increased interactions between p27^kip1 and KPC1 4 days after injury. To understand whether KPC1 plays a role in astrocyte proliferation, we applied LPS to induce astrocyte proliferation in vitro. Western blot analysis demonstrated that p27^kip1 expression was negatively correlated with KPC1 expression following LPS stimulation. Immunofluorescence analysis showed subcellular localizations of p27^kip1 and KPC1 were also changed following the stimulation of astrocytes with LPS. These results suggest that KPC1 is related to the down-regulation of p27^kip1; this event may be involved in the proliferation of astrocytes after SCI.     

Cytoplasmic ubiquitin ligase KPC regulates proteolysis of p27(Kip1) at G1 phase

The cyclin-dependent kinase inhibitor p27(Kip1) is degraded at the G0-G1 transition of the cell cycle by the ubiquitin-proteasome pathway. Although the nuclear ubiquitin ligase (E3) SCF(Skp2) is implicated in p27(Kip1) degradation, proteolysis of p27(Kip1) at the G0-G1 transition proceeds normally in Skp2(-/-) cells. Moreover, p27(Kip1) is exported from the nucleus to the cytoplasm at G0-G1 (refs 9-11). These data suggest the existence of a Skp2-independent pathway for the degradation of p27(Kip1) at G1 phase. We now describe a previously unidentified E3 complex: KPC (Kip1 ubiquitination-promoting complex), consisting of KPC1 and KPC2. KPC1 contains a RING-finger domain, and KPC2 contains a ubiquitin-like domain and two ubiquitin-associated domains. KPC interacts with and ubiquitinates p27(Kip1) and is localized to the cytoplasm. Overexpression of KPC promoted the degradation of p27(Kip1), whereas a dominant-negative mutant of KPC1 delayed p27(Kip1) degradation. The nuclear export of p27(Kip1) by CRM1 seems to be necessary for KPC-mediated proteolysis. Depletion of KPC1 by RNA interference also inhibited p27(Kip1) degradation. KPC thus probably controls degradation of p27(Kip1) in G1 phase after export of the latter from the nucleus.     

KPC1 alleviates hypoxia/reoxygenation-induced apoptosis in rat cardiomyocyte cells though BAX degradation

Bax triggers cell apoptosis by permeabilizing the outer mitochondrial membrane, leading to membrane potential loss and cytochrome c release. However, it is unclear if proteasomal degradation of Bax is involved in the apoptotic process, especially in heart ischemia-reperfusion (I/R)-induced injury. In the present study, KPC1 expression was heightened in left ventricular cardiomyocytes of patients with coronary heart disease (CHD), in I/R-myocardium in vivo and in hypoxia and reoxygenation (H/R)-induced cardiomyocytes in vitro. Overexpression of KPC1 reduced infarction size and cell apoptosis in I/R rat hearts. Similarly, the forced expression of KPC1 restored mitochondrial membrane potential (MMP) and cytochrome c release driven by H/R in H9c2 cells, whereas reducing cell apoptosis, and knockdown of KPC1 by short-hairpin RNA (shRNA) deteriorated cell apoptosis induced by H/R. Mechanistically, forced expression of KPC1 promoted Bax protein degradation, which was abolished by proteasome inhibitor MG132, suggesting that KPC1 promoted proteasomal degradation of Bax. Furthermore, KPC1 prevented basal and apoptotic stress-induced Bax translocation to mitochondria. Bax can be a novel target for the antiapoptotic effects of KPC1 on I/R-induced cardiomyocyte apoptosis and render mechanistic penetration into at least a subset of the mitochondrial effects of KPC1.