噬菌体治疗肺炎克雷伯菌感染的研究进展

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。     

肺炎克雷伯菌噬菌体解聚酶的研究进展

肺炎克雷伯菌(Klebsiella pneumoniae)是在临床引起多种感染的常见条件致病菌之一。多重耐药肺炎克雷伯菌株的出现,给防控细菌感染带来了巨大阻力。肺炎克雷伯菌噬菌体编码的解聚酶是一种稳定性高、特异性强的生物酶,具有分解细菌胞外多糖、限制细菌生长等多种功能。解聚酶可为防控肺炎克雷伯菌感染提供新思路,在抗菌应用中具有广阔前景。本文就肺炎克雷伯菌噬菌体解聚酶的研究进展进行综述。     

一株肺炎克雷伯菌噬菌体的生物学特性及全基因组分析

【背景】随着抗生素的广泛使用甚至滥用,细菌耐药性问题日益显著,利用噬菌体治疗耐药致病菌的方法重新开始被人们关注。【目的】对一株烈性肺炎克雷伯菌噬菌体vB_KpnP_IME279进行生物学特性研究及生物信息学分析。【方法】以一株多重耐药的肺炎克雷伯菌为宿主菌,从医院污水中分离噬菌体,应用双层平板法检测噬菌体效价、最佳感染复数(Optimal MOI)、一步生长曲线以及裂解谱,纯化后通过透射电镜观察噬菌体形态;应用蛋白酶K/SDS法提取噬菌体全基因组,使用Illumina MiSeq测序平台进行噬菌体全基因组测序,测序后对噬菌体全基因组序列进行组装、注释、进化和比较基因组学分析。【结果】分离到一株新的肺炎克雷伯菌噬菌体,命名为vB_KpnP_IME279;其最佳感染复数为0.1,一步生长曲线显示潜伏期为20 min,平均裂解量140 PFU/cell,电镜观察显示该噬菌体属于短尾噬菌体科(Podoviridae)。基因组测序表明,噬菌体基因组全长为42 518 bp,(G+C)mol%含量为59.3%。BLASTn比对结果表明,该噬菌体与目前已知噬菌体的相似性较低,基因组仅70%区域与已知噬菌体有同源性。构建噬菌体主要衣壳蛋白的基因进化树,分析了噬菌体IME279与其他短尾科噬菌体的进化关系,结果表明该噬菌体是短尾科噬菌体的一名新成员。【结论】分离鉴定了一株新的肺炎克雷伯菌噬菌体,进行了生物学特性、全基因组测序和生物信息学分析,为研究肺炎克雷伯菌噬菌体与宿主之间的相互作用关系以及治疗多重耐药细菌感染奠定了基础。     

外排泵介导肺炎克雷伯菌耐药的研究进展

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。     

肺炎克雷伯菌基因组可移动遗传元件的研究进展

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...     

新生儿感染性肺炎的病原茵状况分析

目的了解本地区新生儿感染性肺炎的病原菌的菌种、构成比及耐药情况,探索临床合理选用抗生素。方法细菌鉴定及药敏试验采用VITEK-60全自动细菌鉴定仪。结果本地区新生儿感染性肺炎的病原菌主要为革兰阴性杆菌（92．81％）,其中以肺炎克雷伯菌最为常见,革兰阳性球菌感染较少（7．19％）。革兰阴性杆菌对头孢二代、三代和氨基糖苷类抗生素的耐药率均较高,对喹诺酮类抗生素耐药率较低。亚胺培南具有良好的抗菌活性。结论肺炎克雷伯菌是本地区新生儿感染性肺炎的主要病原菌。经验性治疗用药可首选亚胺培南、头孢替坦、环丙沙星等,建议临床根据药敏结果选用抗生素。     

大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌超广谱β-内酰胺酶的检测及药敏分析

目的:了解本院大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌中超广谱β-内酰胺酶(ESBLs)细菌的发生率和药敏情况,为防止这3种细菌产ESBLs菌株的传播和抗生素的合理应用提供依据.方法:细菌鉴定用Vitek-32细菌鉴定仪,药敏试验用K-B法,ESBLs初筛用双纸片法,ESBLs确证用NCCLS1999年推荐的确证方法.结果:产ESBLs耐药菌占全部分离菌的33.2%,其中各细菌ESBLs发生率大肠埃希菌为28.6%,肺炎克雷伯菌为34.1%,阴沟肠杆菌为40.5%.对实验所做抗生素,ESBLs阳性株比阴性株具有更高的耐药率和更严重的交叉耐药现象.结论:本院大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌ESBLs发生率较高,较往年有上升趋势,ESBLs菌感染的治疗仍以亚胺培南为首选.     

超广谱β-内酰胺酶肺炎克雷伯菌噬菌体F20的分离鉴定及其对小鼠败血症治疗效果

【背景】肺炎克雷伯菌是引起临床感染的重要条件致病菌之一,肺炎克雷伯菌中产超广谱β-内酰胺酶(Extended-spectrum beta-lactamases,ESBLs)的耐药菌株增多迫切需要找到一种新的治疗方法。【目的】自污水中分离超广谱β-内酰胺酶肺炎克雷伯菌噬菌体,并明确其生物学特性、观察其治疗小鼠产ESBLs肺炎克雷伯菌感染的疗效。【方法】电镜观察F20形态,调查其噬菌谱、生长曲线等生物学特性。建立小鼠败血症感染模型观察F20治疗小鼠肺炎克雷伯菌感染的疗效。【结果】F20在其宿主菌的菌苔上形成裂解性噬菌体所具有的完全透明的噬菌斑,电镜观察F20具典型的有尾噬菌体目长尾病毒科病毒的形态特征。一步生长曲线显示F20的潜伏期为18 min,裂解量为89 PFU/细胞。稳定性试验显示F20在pH 5.0-9.0及50°C环境均具良好稳定性。使用噬菌体F20对败血症小鼠治疗后,治疗组小鼠各外周血和各脏器(肺脏、肝脏、脾脏和肾脏)中的细菌数也显著小于对照组细菌数(P0.001),与对照组相比下降大约1–3数量级。F20治疗败血症小鼠存活率达到87.5%,无毒副作用,而对照组小鼠在1 d内全部死亡,可显著提高小鼠的存活率(P0.001)。【结论】新分离的裂解性噬菌体F20在小鼠体内能安全有效地治疗超广谱β-内酰胺酶肺炎克雷伯菌引起的败血症,可作为生物抗菌剂的有效成分。     

多重耐药肺炎克雷伯菌噬菌体KP002的生物学特性及基因组学研究

以上海某些医院临床分离到的多重耐药肺炎克雷伯菌为宿主菌,从不同环境的污水中分离获得1株肺炎克雷伯菌噬菌体KP002。电子显微镜显示其为有尾噬菌体,头部直径约70nm,尾长约80nm,尾宽约20nm。对其生物学特性进行研究,结果显示此株噬菌体在pH 3~9及4~50℃的环境中具有较高活性;6min吸附率达95%以上;潜伏期为10min,爆发期为50min;裂解量为172pfu/cell。结果表明,该噬菌体对pH值和温度适应范围较宽。对其全基因组进行测序分析,结果显示其基因组为环状双链DNA,全长47 173bp,GC含量为48%。本研究筛选获得1株对pH值和温度适应范围较宽的耐药肺炎克雷伯菌烈性噬菌体KP002,为建立耐药肺炎克雷伯菌的噬菌体库以用于治疗临床多重耐药菌感染提供了新的思路。     

小儿细菌性肺炎痰培养物病原菌构成及耐药性分析

目的 分析肺炎患儿痰培养物中细菌构成及其耐药情况,为小儿细菌性肺炎治疗提供合理使用抗感染药物的依据。 方法 对2019年11月至2020年12月济宁市第一人民医院临床送检的肺炎患儿痰液标本进行病原菌的分离鉴定和药敏试验,收集相关资料,并对小儿肺炎病原菌在临床上的分布特点及其耐药情况进一步分析。 结果 痰液培养阳性患儿183例,其中多重细菌感染患儿16例,共培养出199株细菌(剔除同一患儿的重复菌株),其中革兰阴性菌128株(64.32%),革兰阳性菌71株(35.68%)。主流细菌为肺炎链球菌(19.60%)、金黄色葡萄球菌(16.08%)、卡他莫拉菌(13.57%)、肺炎克雷伯菌(11.06%)和大肠埃希菌(10.05%)。多重细菌感染主要以金黄色葡萄球菌+肺炎克雷伯菌、金黄色葡萄球菌+大肠埃希菌混合为主(共5例,31.25%)。肺炎链球菌和金黄色葡萄球菌对利奈唑胺、万古霉素绝对敏感。卡他莫拉菌对头孢噻肟、头孢曲松、米诺环素等绝对敏感。肠杆菌科中肺炎克雷伯菌和大肠埃希菌药敏结果相似,对阿米卡星、厄他培南、头孢替坦敏感率在95%~100%,对氨苄西林耐药率在95%~100%。肺炎链球菌、金黄色葡萄球菌、卡他莫拉菌对左氧氟沙星敏感率均大于90%,大肠埃希菌、肺炎克雷伯菌对左氧氟沙星不够敏感,但中敏率达到75%以上。 结论 肺炎链球菌、金黄色葡萄球菌、卡他莫拉菌、肺炎克雷伯菌、大肠埃希菌感染是本地肺炎患儿痰液中常见菌,抗生素耐药状况比较严重,亚胺培南对革兰阴性菌混合感染的效果较好,利奈唑胺对阳性菌效果较好;左氧氟沙星可用于革兰阴性和阳性菌混合感染,合理使用抗生素应注意针对性和用药时间,杀灭致病菌的同时尽可能维护正常菌群的平衡。     

Bacteriophages and bacteriophage‐derived endolysins as potential therapeutics to combat Gram‐positive spore forming bacteria

Since their discovery in 1915, bacteriophages have been routinely used within Eastern Europe to treat a variety of bacterial infections. Although initially ignored by the West due to the success of antibiotics, increasing levels and diversity of antibiotic resistance is driving a renaissance for bacteriophage‐derived therapy, which is in part due to the highly specific nature of bacteriophages as well as their relative abundance. This review focuses on the bacteriophages and derived lysins of relevant Gram‐positive spore formers within the Bacillus cereus group and Clostridium genus that could have applications within the medical, food and environmental sectors.     

一株新型牛源肺炎克雷伯菌噬菌体的分离鉴定

【背景】肺炎克雷伯菌(Klebsiella pneumoniae)是一种广泛分布于环境中的重要致病菌,该菌较高的耐药性致其在养殖业中治疗较为困难。【目的】分离一株裂解性肺炎克雷伯菌噬菌体,对分离株进行生物学特性鉴定和基因组学分析。【方法】使用双层平板法从四川省某奶牛场中分离、纯化出一株裂解性噬菌体,测定其裂解谱、热稳定性、酸碱耐受度、最佳感染复数及一步生长曲线等生物学特性,并进行全基因组的测序及注释分析。【结果】得到一株裂解性肺炎克雷伯菌噬菌体vB_Kpn_B01,该噬菌体拥有透明且无晕环的噬菌斑,热稳定性较高,在极酸或极碱环境下不进行裂解活动,特异性较强,属长尾噬菌体科(Siphoviridae)。vB_Kpn_B01全基因组大小为113 227 bp,GC含量为47.97%。注释结果显示噬菌体拥有149个编码序列和25个tRNAs,不含耐药基因及毒力基因。通过噬菌体的进化树分析发现,该噬菌体为Sugarlandvirus。【结论】vB_Kpn_B01拥有高效的生长...     

Efficacy of a Broad Host Range Lytic Bacteriophage Against <Emphasis Type="Italic">E. coli</Emphasis> Adhered to Urothelium

Persistent urinary tract infections (UTI) are often caused by E. coli adhered to urothelium. This type of cells is generally recognized as very tolerant to antibiotics which renders difficult the treatment of chronic UTI. This study investigates the use of lytic bacteriophages as alternative antimicrobial agents, particularly the interaction of phages with E. coli adhered to urothelium and specifically determines their efficiency against this type of cells. The bacterial adhesion to urothelium was performed varying the bacterial cell concentrations and the period and conditions (static, shaken) of adhesion. Three collection bacteriophages (T1, T4, and phiX174 like phages) were tested against clinical E. coli isolates and only one was selected for further infection experiments. Based on the lytic spectrum against clinical isolates and its ability to infect the highest number of antibiotic resistant strains, the T1-like bacteriophage was selected. This bacteriophage caused nearly a 45% reduction of the bacterial population after 2 h of treatment. This study provides evidence that bacteriophages are effective in controlling suspended and adhered cells and therefore can be a viable alternative to antibiotics to control urothelium- adhered bacteria.     

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。     

细菌与噬菌体相互抵抗机制研究进展

噬菌体作为一种侵染细菌的病毒,能够特异性识别宿主细菌。近年来,抗生素的过度使用导致耐药细菌的出现,噬菌体有望成为对抗耐药细菌的新武器。在细菌与噬菌体长期共进化过程中,二者都演化出一系列抵御策略。本文从抑制噬菌体吸附、阻止噬菌体DNA进入、切割噬菌体基因组、流产感染以及群体感应对噬菌体的调控等方面,对细菌抵抗噬菌体的机制以及噬菌体应对细菌的策略进行了综述,同时还列举了细菌和噬菌体相互抵抗机制的检测方法,以期为噬菌体在细菌控制中的应用以及探究细菌抵抗噬菌体的机制提供理论依据。     

Amoxicillin and specific bacteriophage can be used together for eradication of biofilm of <Emphasis Type="Italic">Klebsiella pneumoniae</Emphasis> B5055

Despite the efficacy of antibiotics as well as bacteriophages in treatment of bacterial infections, their role in treatment of biofilm associated infections is still under consideration especially in case of older biofilms. Here, efficacy of bacteriophage alone or in combination with amoxicillin, for eradication of biofilm of Klebsiella pneumoniae B5055 has been assessed. Planktonic cells as well as biofilm of K. pneumoniae B5055 grown in 96-well microtiter plates were exposed to bacteriophage and amoxicillin at various Multiplicity of Infections (MoIs) as well as at three different antibiotic concentrations (512, 256 and 128 μg/ml), respectively. After exposure to 256 μg/ml (MIC) of amoxicillin, bacterial load of planktonic culture as well as 1-day-old biofilm was reduced by a log factor of 4.1 ± 0.31 (P = 0.008) and 1.24 ± 0.27 (P < 0.05), respectively but reduction in the bacterial load of mature biofilm (8-day-old) was insignificant (P = 0.23). When 8-day-old biofilm was exposed to higher antibiotic concentration (512 μg/ml) or phage alone (MoI = 0.01) a log reduction of 2.97 ± 0.11 (P = 0.182) and 3.51 ± 0.19 (P = 0.073), respectively was observed. While on exposing to a combination of both the amoxicillin and phage, a significant reduction (P < 0.01) in bacterial load of the biofilm was seen. Hence, when antibiotic was used in combination with specific bacteriophage a greater destruction of the biofilm structure suggested that the phages could be used successfully along with antibiotic therapy. An added advantage of the combination therapy would be its ability to check formation of resistant mutants that otherwise develop easily upon using phage or antibiotic alone.     

Isolation and Characterisation of Lytic Bacteriophages of Klebsiella pneumoniae and Klebsiella oxytoca

Klebsiella bacteria have emerged as an increasingly important cause of community-acquired nosocomial infections. Extensive use of broad-spectrum antibiotics in hospitalised patients has led to both increased carriage of Klebsiella and the development of multidrug-resistant strains that frequently produce extended-spectrum β-lactamases and/or other defences against antibiotics. Many of these strains are highly virulent and exhibit a strong propensity to spread. In this study, six lytic Klebsiella bacteriophages were isolated from sewage-contaminated river water in Georgia and characterised as phage therapy candidates. Two of the phages were investigated in greater detail. Biological properties, including phage morphology, nucleic acid composition, host range, growth phenotype, and thermal and pH stability were studied for all six phages. Limited sample sequencing was performed to define the phylogeny of the K. pneumoniae- and K. oxytoca-specific bacteriophages vB_Klp_5 and vB_Klox_2, respectively. Both of the latter phages had large burst sizes, efficient rates of adsorption and were stable under different adverse conditions. Phages reported in this study are double-stranded DNA bacterial viruses belonging to the families Podoviridae and Siphoviridae. One or more of the six phages was capable of efficiently lysing ~63 % of Klebsiella strains comprising a collection of 123 clinical isolates from Georgia and the United Kingdom. These phages exhibit a number of properties indicative of potential utility in phage therapy cocktails.     

Structural changes induced by a lytic bacteriophage make ciprofloxacin effective against older biofilm of Klebsiella pneumoniae

Bacteria have evolved multiple mechanisms, such as biofilm formation, to thwart antibiotic action. Yet antibiotics remain the drug of choice against clinical infections. It has been documented that young biofilm of Klebsiella pneumoniae could be eradicated significantly by ciprofloxacin treatment alone. Since age of biofilm is a decisive factor in determining the outcome of antibiotic treatment, in the present study biofilm of K. pneumoniae, grown for extended periods was treated with ciprofloxacin and/or depolymerase producing lytic bacteriophage (KPO1K2). The reduction in bacterial numbers of older biofilm was greater after application of the two agents in combination as ciprofloxacin alone could not reduce bacterial biomass significantly in older biofilms (P > 0.05). Confocal microscopy suggested the induction of structural changes in the biofilm matrix and a decrease in micro-colony size after KPO1K2 treatment. The role of phage associated depolymerase was emphasized by the insignificant eradication of biofilm by a non-depolymerase producing bacteriophage that, however, eradicated the biofilm when applied concomitantly with purified depolymerase. These findings demonstrate that a lytic bacteriophage alone can eradicate older biofilms significantly and its action is primarily depolymerase mediated. However, application of phage and antibiotic in combination resulted in slightly increased biofilm eradication confirming the speculation that antibiotic efficacy can be augmented by bacteriophage.     

TL,the new bacteriophage of <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> and its application for the search of halo-producing bacteriophages

The properties of new virulent bacteriophage TL of Pseudomonas aeruginosa belonging to the family Podoviridae (genome size of 46 kb) were investigated. This bacteriophage is capable of lysing the bacterial lawn in halo zones around negative colonies (NC) of other bacteriophages. TL forms large NC, that are hardly distinguishable on the lawn of P. aeruginisa PAO1. At the same time, on the lawns of some phage-resistant PAO1 mutants, as well as on those produced by a number of clinical isolates, TL forms more transparent NC. It is suggested that more effective growth of the bacteriophage TL NC is associated with the differences in outer lipopolysaccharide (LPS) layer of the cell walls of different bacterial strains, as well as of the bacteria inside and outside of the halos. This TL property was used to optimize selection of bacteriophages producing halos around NC on the lawn of P. aeruginosa PAO1. As a result, a group of bacteriophages differing in the patterns of interaction between their halos and TL bacteriophage, as well as in some characters was identified. Taking into consideration the importance of cell-surfaced structures of P. aeruginosa in manifestation of virulence and pathogenicity, possible utilization of specific phage enzymes, polysacchadide depolymerases, for more effective treatment of P. aeruginosa infections is discussed.