Prevalence of the plasmid-mediated quinolone resistance determinants among clinical isolates of Shigella sp. in Andaman & Nicobar Islands, India

Aims: This study was carried out to find the prevalence of various plasmid‐mediated quinolone‐resistant (PMQR) determinants among the quinolone‐resistant clinical isolates of Shigella sp. from paediatric patients in Andaman & Nicobar Islands. Methods and Results: A total of 106 quinolone‐resistant Shigella isolates obtained from paediatric patients during hospital‐based surveillance from January 2003 to June 2010 were screened for the presence of various PMQR determinants. Of 106 isolates, 8 (7·5%) showed the presence of aac (6′)‐Ib‐cr and 3 (2·8%) harboured the qnrB genes with 2 (1·9%) of these isolates showing the presence of both. All the 9 isolates had uniform mutations in gyrA (S83L) and in parC (S80I). Conclusions: The prevalence of fluoroquinolone‐acetylating aminoglycoside acetyltransferase {aac (6′)‐Ib‐cr} gene is higher than qnrB gene among the clinical Shigella isolates. These PMQR determinants were detected in the Shigella isolates obtained from 2008–2010, indicating that it happens in a stepwise manner following the multiple mutations in quinolone resistance‐determining regions increase or extend resistance to quinolones or fluoroquinolones. Significance and Impact of Study: The prevalence of these genes are of grave concern as it may be horizontally transferred to other human pathogenic bacteria and can lead to therapeutic failure as a consequence of antimicrobial resistance, not only for the islands but also for the entire south‐east region. The results obtained should encourage further studies on the implications of the presence, distribution, association and variation of these determinants in our quest for understanding PMQR.     

Shigella in Brazilian children with acute diarrhoea: prevalence,antimicrobial resistance and virulence genes

Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children''s Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.     

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。     

喹诺酮外排泵耐药基因oqxAB的耐药机制及其流行情况

oqx AB是编码Oqx AB外排泵蛋白的多重耐药基因,由2个开放阅读框oqx A和oqx B组成,其主要介导细菌对喹诺酮类药物的耐药。该基因最早是在大肠埃希菌pOLA52质粒上被发现,是质粒介导的喹诺酮耐药基因的重要成员之一。目前已经分别发现了11个oqxA和32个oqxB等位基因。oqxAB通过质粒进行水平传播,使受体菌株容易形成耐药性,增加了临床治疗的难度。该基因目前主要流行于肠杆菌科,但不能排除也存在于非肠杆菌科细菌,给人类与家畜健康造成巨大的威胁。本文综述了喹诺酮外排泵耐药基因oqxAB及其等位基因的发现、耐药机制、国内外流行特点,以期为临床和畜牧生产中合理使用喹诺酮类抗菌药物,减少oqxAB基因的流行提供资料。     

汉中市中心医院细菌性痢疾志贺菌16S rRNA序列分析、毒力基因与耐药检测

目的对汉中市中心医院细菌性痢疾患者分离的70株志贺菌进行16S rRNA序列分析、毒力基因与耐药检测。方法对2018年6月至2018年12月我院收治的细菌性痢疾患者进行病原菌分离鉴定,并进行16S rRNA遗传进化分析;PCR法检测其6种毒力基因;K-B法检测其对8种抗生素的敏感性。结果 16S rRNA测序结果显示,福氏志贺菌感染率为57.14%(40/70),宋内志贺菌感染率为42.86%(30/70)。16S rRNA系统进化分析结果显示,40株福氏志贺菌与参考菌株(NR_026331.1)同源性为95.2%～99.0%,30株宋内志贺菌与参考菌株(NR_104826.1)同源性为96.3%～99.9%。毒力基因检测结果表明,70株志贺菌均可以检测出6个相关毒力基因set1A、set1B、sen、Ial、ipaH、virA,毒力基因检出率最高的为ipaH,达到100.00%,其次为Ial、virA,均达到90.00%;其中福氏志贺菌set1A、set1B、Ial基因的检出率高于宋内志贺菌,sen和virA基因的检出率低于宋内志贺菌,二者ipaH基因的检出率都为100.00%。药敏试验结果表明,70株志贺菌耐药率最高的抗生素为氨苄西林,耐药率达到80.00%,其次为强力霉素,耐药率达到75.71%,耐药率最低的为头孢吡肟,耐药率为20.00%;其中40株福氏志贺菌耐药率最高的抗生素为强力霉素,其次为氨苄西林,最低的为头孢吡肟;30株宋内志贺菌耐药率最高的抗生素为氨苄西林,其次为哌拉西林,最低的为氧氟沙星。结论 2018年下半年汉中市中心医院从细菌性痢疾患者身上分离得到的志贺菌主要为福氏志贺菌与宋内志贺菌,毒力基因检测和耐药性试验结果显示分离菌株有较强致病性,提示对细菌性痢疾的监测、防控与治疗应进一步加强。     

Detecting low concentrations of Shigella sonnei in environmental water samples by PCR

Outbreaks of Shigella sonnei associated with contaminated water have been reported and methods for the simultaneous detection of Shigellae and enteroinvasive Escherichia coli in water samples have been developed with detection limits of 10(1)-10(2) CFU mL(-1) of water. Because 10(1)-10(2)Shigellae can cause disease, a more sensitive detection method as an addition to the existing methods for detection of Shigella sonnei in water samples is reported here. Initially, 33 Shigella sonnei and 72 non-Shigella sonnei isolates were tested and one primer pair was found capable of specifically amplifying a 369-bp insertion sequence 1 (IS1) fragment from all 33 Shigella sonnei isolates and one Shigella dysenteriae ATCC isolate by PCR. The detection method was developed, which included filtration of 50 mL of water through a membrane and application of PCR to the membrane using this primer pair. Environmental water samples with total bacterial numbers of 384-2.84 x 10(7) CFU L(-1) were collected and seeded with 13 Shigella sonnei and the Shigella dysenteriae ATCC isolates. Detection limits were determined as 1.7-24.7 and 270-8000 CFU per 50 mL of water, respectively, using this detection method.     

Analysis of gyrA and parC mutations in enterococci from environmental samples with reduced susceptibility to ciprofloxacin

The quinolone resistance determining regions of gyrA and parC in four species of enterococci from environmental samples with reduced susceptibility to ciprofloxacin were sequenced. The nucleotide sequence variations of parC could be related to the different enterococcal species. Mutations in Enterococcus faecalis and Enterococcus faecium related to reduced susceptibility were identical to mutations detected in E. faecalis and E. faecium of clinical origin. A minimal inhibitory concentration of 8 microg ml(-1) to ciprofloxacin was not associated with any mutations in the gyrA and parC gene of Enterococcus casseliflavus and Enterococcus gallinarum. These two species may be intrinsically less susceptible to ciprofloxacin.     

Relative contribution of target gene mutation and efflux to varying quinolone resistance in Irish Campylobacter isolates

The contribution of target gene mutations and active efflux to varying levels of quinolone resistance in Irish Campylobacter isolates was studied. The Thr-86-Ile modification of GyrA did not correlate with the level of quinolone resistance. The efflux pump inhibitor Phe-Arg-beta-Naphthylamide (PAbetaN) had no effect on the MICs to ciprofloxacin. In contrast, a PAbetaN sensitive efflux system contributed to the low-level nalixidic acid resistance phenotype. The lack of effect of PAbetaN in high-level resistant nalidixic isolates may be attributable to mutations identified in the CmeB efflux pump of these isolates. PAbetaN may have limited diagnostic value in the assessment of the contribution of efflux pump activity to ciprofloxacin resistance in Campylobacter.     

Gemifloxacin can partially overcome quinolone resistance of H. pylori with gyrA mutation in Taiwan

Backgrounds: The levofloxacin resistance caused by gyrA gene mutation is rising rapidly to limit wide application for Helicobacter pylori eradication. We investigated whether gemifloxacin has a superior antimicrobial activity to levofloxacin against H. pylori. Materials and Methods: Forty‐four consecutive clinical H. pylori isolates with levofloxacin resistance and 80 randomly selected levofloxacin‐sensitive controls were tested for gemifloxacin sensitivity by E‐test. The resistance to levofloxacin or gemifloxacin was defined as minimal inhibitory concentration (MIC) >1 mg/L. The clinical features and GyrA mutation patterns checked by direct sequencing were also analyzed to assess its association with the H. pylori gemifloxacin resistance. Results: All levofloxacin‐sensitive H. pylori isolates were sensitive to gemifloxacin. Eight strains (18.2%) resistant to levofloxacin could be still sensitive to gemifloxacin. Gemifloxacin achieved a 5‐time lower in MIC levels against levofloxacin‐resistant isolates. Nearly all levofloxacin‐resistant isolates (97.7%, 43/44) had GyrA mutation at amino acid position 87 or 91. Double mutation sites may play dual roles in quinolone resistance, as N87K plus H57Y or D91N plus V77A mutations showed high‐level resistance to both quinolones; whereas D91Y plus A97V or D91N plus A97V mutations showed low level levofloxacin resistance to become sensitive to gemifloxacin. In H. pylori isolates with single N87K, D91Y or D91N mutation, near 20% was gemifloxacin‐sensitive and levofloxacin‐resistant. The gemifloxacin‐resistant rate of H. pylori was higher in patients with gastric ulcer than in those without (p <.05). Conclusion: Gemifloxacin is superior to levofloxacin in antimicrobial activity against clinical H. pylori isolates, and even overcome some levofloxacin resistance.     

I-CeuI fragment analysis of the Shigella species: evidence for large-scale chromosome rearrangement in S. dysenteriae and S. flexneri

I-CeuI fragments of four Shigella species were analyzed to investigate their taxonomic distance from Escherichia coli and to collect substantiated evidence of their genetic relatedness because their ribosomal RNA sequences and similarity values of their chromosomal DNA/DNA hybridization had proved their taxonomic identity. I-CeuI digestion of genomic DNAs yielded seven fragments in every species, indicating that all the Shigella species contained seven sets of ribosome RNA operons. To determine the fragment identities, seven genes were selected from each I-CeuI fragment of E. coli strain K-12 and used as hybridization probes. Among the four Shigella species, S. boydii and S. sonnei showed hybridization patterns similar to those observed for E. coli strains; each gene probe hybridized to the I-CeuI fragments with sizes similar to that of the corresponding E. coli fragment. In contrast, S. dysenteriae and S. flexneri showed distinct patterns; rcsF and rbsR genes that located on different I-CeuI fragments in E. coli, fragments D and E, were found to co-locate on a fragment. Further analysis using an additional three genes that located on fragment D in K-12 revealed that some chromosome rearrangements involving the fragments corresponding to fragments D and E of K-12 took place in S. dysenteriae and S. flexneri.     

The prevalence of plasmid‐mediated quinolone resistance determinants among clinical isolates of ESBL or AmpC‐producing Escherichia coli from Chinese pediatric patients

Three kinds of PMQR determinants (qnr genes, aac(6’)‐Ib‐cr, and qepA) have been discovered and shown to be widely distributed among clinical isolates. To characterize the prevalence of PMQR determinants in ESBL or AmpC‐producing E. coli clinical isolates in Chinese children, a total of 292 ESBL or AmpC‐producing E. coli clinical isolates collected from five children's hospitals in China from 2005 to 2006 were screened for PMQR determinants by PCR. Twenty (6.8%) of the 292 isolates were positive for PMQR determinants. A total of 12 (4.1%) isolates were positive for qnr genes, comprising three positive for qnrA (1.0%), three for qnrB (1.0%), and six for qnrS (2.1%). Twenty‐four (8.2%) isolates were positive for aac(6’)‐Ib, of which 10 (3.4% of 292) had the –cr variant. There was no qepA gene detected in the isolates. Conjugation revealed that qnr, aac(6’)‐Ib‐cr, and ESBL‐encoding genes were transferred together.     

Adhesion and invasion of a mutant Shigella flexneri to an eukaryotic cell line in absence of the 220-kb virulence plasmid

A Shigella flexneri strain, cured of the large 220-kb virulence plasmid, expresses adhering and invading ability in confluent monolayers of HeLa cells similar to its parent strain. Invasion by both the parent and the cured strains resulted in alteration of the monomeric actin (G) in the total actin pool of HeLa cells. Other indicators of invasive characteristics of virulent Shigella strains such as production of keratoconjunctivitis in guinea pig eye in vivo, Congo red binding and expression of contact hemolysin however, indicated loss of invasive properties in the plasmid cured strain. Further, pretreatment of bacterial cells with para-bromophenacyl bromide (p-BPB), a specific chemical inhibitor of phospholipase A, adversely affected adhesion to and invasion of HeLa cells in vitro, irrespective of the presence of the 220-kb plasmid indicating the possible involvement of the enzyme phospholipase A in the invasion process. Adherence of both the strains to guinea pig colonic epithelial cells (CECs) in vitro was reduced significantly on pretreatment of bacteria or CECs with p-BPB. Expression of exocellular enzymes viz. protease, elastase, phospholipase A and phospholipase C were not related to the large plasmid.     

矿泉水和山泉水中铜绿假单胞菌污染调查及分离菌株毒力基因与耐药性分析

【目的】初步掌握全国矿泉水和山泉水生产过程中铜绿假单胞菌(Pseudomonas aeruginosa)的污染情况。分析矿泉水与山泉水中铜绿假单胞菌的致病性与耐药性。【方法】研究通过对广西、湖北、云南等全国9个省36家水厂进行采样,共采集108个样本,并根据《饮用天然矿泉水检测方法》国家标准(GB/T 8538-2008)检测其铜绿假单胞菌的污染率、污染水平。对分离出的铜绿假单胞菌菌株进行毒力基因与药敏实验。【结果】全国矿泉水水源水、活性碳过滤后水、成品水的污染率分别为16.7%、16.7%、0,污染水平分别为3.7、2.0、0 CFU/250 m L。全国山泉水水源水、活性碳过滤后水、成品水的污染率分别为66.7%、83.3%、5.6%,污染水平分别为5.1、7.3、2.0 CFU/250 m L。对所分离出的36株铜绿假单胞菌进行毒力基因检测和药敏试验显示:exo U、exo S、phz M、tox A、las B检出率分别为25.0%、75.0%、100%、88.8%、100%,但对美国国家临床实验室标准化委员会标准中14种抗生素均无耐药性。【结论】山泉水水源水、活性碳过滤后水、成品水污染率明显高于矿泉水,但污染水平均较低,无大于40.0 CFU/250 m L样品检出。山泉水活性碳过滤后污染率最高,表明大部分企业在活性碳过滤环节存在污染问题。毒力基因exo U、exo S、phz M、tox A、las B在分离到的36株铜绿假单胞菌检出率高,但分离到的菌株对所选取的14种抗生素均无耐药性。     

云南土壤宏基因组文库中替加环素耐药基因的筛选与分析

[背景]随着抗生素的广泛应用以及滥用,出现了多重耐药的"超级细菌",并且在临床上已出现对治疗"超级细菌"感染的最后一线抗生素——替加环素耐药的细菌.[目的]对土壤环境中存在的替加环素耐药基因进行筛选调查,探讨替加环素耐药机制,为临床抗生素治疗提供借鉴.[方法]利用功能宏基因组学技术对土壤宏基因组文库进行替加环素耐药阳性...     

临床分离志贺菌中CRISPR/Cas系统的分布及其与毒力基因的关系

【目的】了解临床分离志贺菌中CRISPR/Cas系统的分布特征并分析其与毒力基因的关系。【方法】以聚合酶链式反应(PCR)方法,采用10对引物分别对57株临床分离志贺菌中CRISPR1、cas2-cas1、cas6e-cas5、cas7、cse2、cse1-cas3基因和毒力基因ipaH、ial、ipaBCD、virA进行检测。对CRISPR1的PCR结果进行测序,并用CRISPR finder在线软件对CRISPR1基因座进行分析。通过卡方检验初步分析CRISPR/Cas系统与毒力基因的关系。【结果】测序结果显示,CRISPR1基因座中间隔序列数目较少且在不同菌株间一致性较高;57株志贺菌中,84.2% (48/57)的志贺菌中可检测到CRISPR/Cas系统,其中68.8% (33/48)的志贺菌中cas6e-cas5基因或(和) cse2基因中发现插入序列;毒力基因ipaH、ial、virA、ipaBCD的检出率依次为100%、100%、98.2%和87.7%;毒力基因ipaBCD的阳性率与活性CRISPR/Cas系统的分布无关(P>0.05)。【结论】CRISPR/Cas系统广泛存在于临床分离志贺菌中;部分cas基因中有插入序列;并未发现志贺菌中活性CRISPR/Cas系统与毒力基因的分布有关。     

Two different mechanisms are involved in the extremely high-level benzalkonium chloride resistance of a Pseudomonas fluorescens strain

A Pseudomonas fluorescens strain, PFRB, which we previously isolated as a contaminant in a batch of benzalkonium chloride (BAC) stock solution, exhibits high-level resistance, not only to BAC, but also to other cationic surfactants belonging to disinfectants classified as quaternary ammonium compounds (QACs). In this study, we analyzed the resistance mechanism of the strain to BAC and other disinfectants. We obtained results suggesting that two different mechanisms, reduced adsorption of BAC to the cell surface and an energy-dependent mechanism which is most probably an efflux system, were implicated in the high-level resistance to BAC. Reduced adsorption of BAC is likely due to the decreased negative cell surface charge of the strain. The putative efflux system seems to be unique in that it excretes only a certain range of cationic membrane-acting disinfectants belonging to QACs.