耐碳青霉烯鲍曼不动杆菌插入序列及其水平传播

目的 了解我院耐碳青霉烯类鲍曼不动杆菌的临床分布并探讨插入序列与其耐药的关系,分析水平传播能力,为指导医院感染及临床合理应用抗菌药物提供科学依据。方法 收集2013年9月‒2015年6月我院临床分离鲍曼不动杆菌,经VITEK-II全自动细菌分析系统鉴定细菌并检测16S rRNA,Walkway-40/药敏测试系统进行药敏检测;多重PCR检测鲍曼不动杆菌携带β-内酰胺酶（A、B、C、D类）相关耐药基因。检测上游插入序列ISAba1与OXA-23、OXA-51、ADC连锁表达,并分析ISAbal与耐药基因OXA-23、ADC的相关性。质粒接合试验验证OXA碳青霉烯酶基因的水平转移。结果 耐碳青霉烯类的鲍曼不动杆菌（CRAB）与碳青霉烯类敏感的鲍曼不动杆菌（CSAB）抗生素耐药率差异有统计学意义（Ps<0.01）。CRAB与CSAB产酶基因（OXA-23、ADC、TEM）检出率差异明显。50株CRAB中40株检测出ISAbal-OXA-23连锁基因,1株检测出ISAbal-OXA-51连锁基因。接合试验阳性株检测出OXA-23、OXA-24、OXA-51及插入序列。结论 我院CRAB主要是产OXA-23、OXA-24、OXA-51、ADC、TEM型碳青霉烯酶,ISAbal常出现在OXA-23基因上游,ISAbal-OXA-23可能是CRAB重要的耐药机制。     

Ebsulfur as a potent scaffold for inhibition and labelling of New Delhi metallo-β-lactamase-1 in vitro and in vivo

The superbug infection caused by New Delhi metallo-β-lactamase (NDM-1) has grown into an emerging threat, labelling and inhibition of NDM-1 has proven challenging due to its shuttling between pathogenic bacteria. Here, we report a potent covalent scaffold, ebsulfur, for targeting the protein in vitro and in vivo. Enzymatic kinetic study indicated that eighteen ebsulfurs gained except 1a–b and 1f inhibited NDM-1, exhibiting an IC₅₀ value ranging of 0.16–9 μM, and 1g was found to be the best, dose- and time-dependent inhibitor with an IC₅₀ of 0.16 μM. Also, these ebsulfurs effectively restored the antibacterial activity of cefazolin against E. coli expressing NDM-1, and the best effect was observed to be from 1g, 1i and 1n, resulting in an 256-fold reduction in MIC of the antibiotic at a dose of 16 μg/mL. The equilibrium dialysis study implied that the ebsulfur disrupted the coordination of one Zn(II) ion at active site of NDM-1. Labelling of NDM-1 using a constructed fluorescent ebsulfur Ebs-R suggested that the inhibitor covalently bound to the target through SDS-PAGE analysis in vitro. Also, labelling NDM-1 in living E. coli cells with Ebs-R by confocal microscopic imaging showed the real-time distribution change process of intracellular recombinant protein NDM-1. Moreover, the cytotoxicity of these ebsulfurs against L929 mouse fibroblastic cells was tested, and their capability to restore antibacterial activity of antibiotic against clinical strains E. coli EC08 producing NDM-1 was determined. The ebsulfur scaffold proposed here is valuable for development of the covalent irreversible inhibitors of NDM-1, and also for labelling the target in vitro and in vivo.     

A structural view of the antibiotic degradation enzyme NDM-1 from a superbug

Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are a type of newly discovered antibiotic-resistant bacteria. The rapid pandemic spread of NDM-1 bacteria worldwide (spreading to India, Pakistan, Europe, America, and Chinese Taiwan) in less than 2 months characterizes these microbes as a potentially major global health problem. The drug resistance of NDM-1 bacteria is largely due to plasmids containing the blaNDM-1 gene shuttling through bacterial populations. The NDM-1 enzyme encoded by the blaNDM-1 gene hydrolyzes β-lactam antibiotics, allowing the bacteria to escape the action of antibiotics. Although the biological functions and structural features of NDM-1 have been proposed according to results from functional and structural investigation of its homologues, the precise molecular characteristics and mechanism of action of NDM-1 have not been clarified. Here, we report the three-dimensional structure of NDM-1 with two catalytic zinc ions in its active site. Biological and mass spectroscopy results revealed that D-captopril can effectively inhibit the enzymatic activity of NDM-1 by binding to its active site with high binding affinity. The unique features concerning the primary sequence and structural conformation of the active site distinguish NDM-1 from other reported metallo-β-lactamases (MBLs) and implicate its role in wide spectrum drug resistance. We also discuss the molecular mechanism of NDM-1 action and its essential role in the pandemic of drug-resistant NDM-1 bacteria. Our results will provide helpful information for future drug discovery targeting drug resistance caused by NDM-1 and related metallo-β-lactamases.     

Interaction of sulbactam, clavulanic acid and tazobactam with penicillin-binding proteins of imipenem-resistant and -susceptible acinetobacter baumannii

Abstract We have encountered clinical isolates of Acinetobacter baumannii which are resistant to all available antibiotics used in hospitals except for polymyxin B and the beta-lactamase inhibitor, sulbactam. To investigate the mechanisms of this unique activity, affinities of sulbactam and other beta-lactamase inhibitors for penicillin binding proteins were compared using imipenem-resistant and imipenem-sensitive isolates. The results of competition binding experiments indicate that all three beta-lactamase inhibitors bound to imipenem-susceptible Acinetobacter . Binding of sulbactam was greater than that of tazobactam and not detected with clavulanic acid to penicillin binding proteins of the imipenem-resistant strain of Acinetobacter .     

In silico based unraveling of New Delhi metallo-β-lactamase (NDM-1) inhibitors from natural compounds: a molecular docking and molecular dynamics simulation study

Abstract

The development of pathogenic microbial resistance toward antibiotics has become a global clinical concern. New Delhi metallo-β-lactmase-1 (NDM-1) and its variants have recently drawn immense attention for its biological ability to catalyze the hydrolysis of almost all of β-lactam antibiotics including the Carbapenems which are generally considered as the last-resort antibiotics. Also, the horizontal gene transfer is expediting the rapid spread of NDM-1 in bacteria. In the wake of this serious antibiotic resistance problem it becomes imperative to find inhibitors which can render the present antibiotics functional and useful. In the present study, we have used Molecular docking and Molecular Dynamics (MD) simulation approach to find out suitable inhibitors against NDM-1 from an array of different natural compounds. We have screened unique natural compounds from ZINC database and also a set of standard antibiotics and inhibitors. Based upon the highest binding affinity demonstrated by docking with NDM-1, the best binding antibiotic Meropenem and the top five natural compounds, viz., Withaferin A, Beta-Sitosterol, Aristolochic acid, Diosgenin and Guggulsterone E were selected and subjected to MD simulations study. The docked NDM-1 complex with withaferin A, beta-sitosterol and diosgenin were found to be more stable as compared to the one with meropenem throughout the MD simulation process with the relative RMSD and RMSF in acceptable range. In conclusion, these compounds can be readily tested in vitro and in vivo to fully establish and confirm their inhibition potentiality and can also serve as lead molecules for the development of future functional inhibitors.

Communicated by Ramaswamy H. Sarma     

鲍曼不动杆菌感染的分布特点及药敏分析

目的了解鲍曼不动杆菌感染分布情况及对20种抗生素耐药性分析。方法送检标本按照《全国临床检验操作规程》（第2版）微生物方法操作,用Vitek—Systems ATB法国生物,梅里埃微生物分析仪,并结合传统手工非发酵微量生化管编码补充试验进行菌种鉴定;药敏试验采用K—B琼脂纸片扩散法及法国梅里埃ATB试条。结果112株鲍曼不动杆菌中有93株（83％）来自于上呼吸道（痰液及咽拭子）：药敏结果显示鲍曼不动杆菌对氨基糖苷类（阿米卡星、庆大霉索）,喹诺酮类（环丙沙星）,碳青酶烯类（亚胺培南）具有较高的敏感率。对β-呐酰胺类抗生素有较高的耐药性,在检测的112株鲍曼不动杆菌中,多重耐药菌株占54．5％（61／112）,三重耐药株占14．8％,而在这些多重耐药菌株中,大于三重耐药的菌株就占到69％。结论鲍曼不动杆菌对抗菌药物已产生多重耐药性,应重视该菌感染及耐药性监测,阻止多重耐药菌株的播散,预防医院感染的发生。     

泛耐药基因NDM-1在大肠杆菌中的克隆表达及耐药性检测

目的:构建bla(NDM-1)基因重组质粒,表达新德里金属β内酰胺酶1(NDM-1),并检测携带bla(NDM-1)基因重组质粒的大肠杆菌的耐药状况。方法:PCR扩增编码NDM-1的基因bla(NDM-1),构建表达载体pGEX4T-1-NDM-1,并转化至大肠杆菌,转化子经PCR后测序,以确认构建和转化成功;用Western印迹验证重组蛋白的表达;用药敏纸片法检测含重组质粒pGEX4T-1-NDM-1的大肠杆菌的耐药谱;用E-test法测定其最低抑菌浓度(MIC)。结果:PCR及测序结果显示载体构建和转化成功;含重组质粒pGEX4T-1-NDM-1的大肠杆菌在37℃时,经1 mmol/LIPTG诱导5 h后,SDS-PAGE可见目的条带;除对替加环素和粘菌素敏感外,该重组子对多种碳青霉烯类抗生素耐药,E-test检测其对亚胺培南的MIC为64μg/mL。结论:构建了含泛耐药基因bla(NDM-1)的重组质粒,转入大肠杆菌后表达了融合蛋白,并对多种碳青霉烯类抗生素耐药。为进一步研究bla(NDM-1)基因和蛋白的功能奠定了基础。     

鲍曼不动杆菌的临床分布特点及耐药性分析

调查鲍曼不动杆菌的临床分布及其对抗菌药物的耐药情况,为临床合理用药提供依据。将哈尔滨医科大学第一附属医院临床各种来源的鲍曼不动杆菌1582株采用K-B法进行药敏试验,并对结果进行统计分析。2008至2010年共检出鲍曼不动杆菌1582株,临床分布以ICU最多(484株,占54.5%)。对抗菌药物的耐药率逐年增高,ICU抗菌药物的耐药率明显高于非ICU病区。该菌株对临床常用抗菌药物高度耐药和多重耐药,对亚胺培南和美罗培南耐药率高达90.9%和90.3%。鲍曼不动杆菌耐药情况相对严重,临床须重视鲍曼不动杆菌的感染,加强院內感染的控制及耐药性的监测,根据药敏结果选择合适抗生素,延缓耐药性进程。     

呼吸内科重症监护室一起多重耐药鲍曼不动杆菌感染暴发的调查

目的及时发现医院感染暴发苗头,查找感染源,切断传播途径,最大限度减少医院感染发生。方法对2009年4月26～28日期间RICU发生的4例鲍曼不动杆菌感染病例进行聚集感染危险因素调查,采集标本进行目标菌检测,应用ERIC—PCR技术对聚集病例和散发病例菌株进行基因同源性分析,采取综合性防控措施进行医院感染具体干预。结果4例患者确定为医院感染病例,4例患者均有气管插管操作经历,3例患者环境卫生学检测存在耐药谱相同的鲍曼不动杆菌,ERIC—PCR分析4例患者检出的鲍曼不动杆菌具有基因同源性,确定为医院感染暴发。严格执行隔离防护措施和后续加强上呼吸机患者管理,未再出现聚集病例。结论医院感染暴发危及患者医疗安全,应用分子生物学分析手段可以促进医院感染防控措施的效果;加强上呼吸机患者的管理,加强手卫生的管理可以有效防控医院感染聚集暴发。     

鲍曼不动杆菌无痕基因敲除及hcp基因相关功能

[背景]鲍曼不动杆菌耐药严重,基因敲除是研究细菌毒力与耐药的重要方式.但现有的大部分细菌基因敲除方法基于抗生素抗性筛选,导致不适用于多重耐药菌株的基因敲除.[目的]旨在建立一种非依赖于抗生素抗性筛选的方法,用于敲除多重耐药鲍曼不动杆菌基因.[方法]运用同源 重组和自杀载体pMo 130-TelR对亚碲酸钾的抗性,使用两...     

ICU鲍曼不动杆菌感染特点及耐药趋势

目的探讨武义县第一人民医院中心ICU鲍曼不动杆菌（AB）感染特点及耐药情况。方法回顾分析2010年1月至2013年12月该院中心ICU患者分离获得的AB分布、耐药特点及临床患者资料。结果该院ICU共分离获得AB菌343株,主要来源于痰液（占67.35%）,其次是创面分泌物（占11.08%）。AB对常用头孢类、碳青霉烯类、氨基糖苷类、喹诺酮类等药物耐药率高达50%以上,而对多粘菌素E、头孢哌酮/舒巴坦保持敏感性,但后两者的耐药性呈逐年上升趋势。泛耐药（PDR）AB患者血清白蛋白水平明显减低,机械通气时间、抗菌药物应有时间、ICU住院时间明显延长,死亡率增高（P〈0.05）。结论 ICU获得性AB耐药率极高,仅对多粘菌素E、头孢哌酮/舒巴坦具有相对敏感性。白蛋白水平、机械通气时间、应用抗菌药物时间、ICU住院时间等可能与PDRAB感染有关。     

Characterization of a highly virulent and antimicrobial‐resistant Acinetobacter baumannii strain isolated from diseased chicks in China

Poultry husbandry is a very important aspect of the agricultural economy in China. However, chicks are often susceptible to infectious disease microorganisms, such as bacteria, viruses and parasites, causing large economic losses in recent years. In the present study, we isolated an Acinetobacter baumannii strain, CCGGD201101, from diseased chicks in the Jilin Province of China. Regression analyses of virulence and LD₅₀ tests conducted using healthy chicks confirmed that A. baumannii CCGGD201101, with an LD₅₀ of 1.81 (±0.11) × 10⁴ CFU, was more virulent than A. baumannii ATCC17978, with an LD₅₀ of 1.73 (±0.13) × 10⁷ CFU. Moreover, TEM examination showed that the pili of A. baumannii CCGGD201101 were different from those of ATCC17978. Antibiotic sensitivity analyses showed that A. baumannii CCGGD201101 was sensitive to rifampicin but resistant to most other antibiotics. These results imply that A. baumannii strain CCGGD201101 had both virulence enhancement and antibiotic resistance characteristics, which are beneficial for A. baumannii survival under adverse conditions and enhance fitness and invasiveness in the host. A. baumannii CCGGD20101, with its high virulence and antimicrobial resistance, may be one of the pathogens causing death of diseased chicks.     

鲍曼不动杆菌的基因分型及耐药性分析

目的分析上海某综合性医院不同科室来源的鲍曼不动杆菌菌株的同源性及耐药状况,了解鲍曼不动杆菌院内感染流行情况。方法采用重复序列PCR技术（REP-PCR）,对51株临床分离的鲍曼不动杆菌菌株进行基因分型,并用纸片扩散法进行药敏试验。结果51株鲍曼不动杆菌分为13个基因型,其中A型16株,为主要流行型别;C型、D型各6株;M型有5株;E型、F型和G型各3株;B型、H型和K型各2株;I型、J型、L型各1株。药敏试验结果显示分离出的菌株对常用抗菌药呈现出多重耐药的现象。其中对阿米卡星和亚胺培南的耐药性最低,均为33.3%;对头孢唑啉耐药性最高,为100%。结论鲍曼不动杆菌基因的同源性分析表明,该院存在着以A型鲍曼不动杆菌为主的感染流行,估计该型菌株可能以克隆株的形式播散。鲍曼不动杆菌的耐药性很强,应加强其耐药性监测,合理使用抗菌药物。     

鲍曼不动杆菌的临床分布及药物敏感性结果分析

目的了解鲍曼不动杆菌的临床分布及药物敏感性分析。方法收集2004年5月至2006年5月抚顺市中心医院住院及门诊患者的临床标本,从中分离鲍曼不动杆菌。质控菌株:大肠埃希菌ATCC 25922,铜绿假单胞菌ATCC 27853,采用美国BD公司生产的凤凰微生物鉴定/药敏分析仪,对62株鲍曼不动杆菌进行鉴定和药物敏感测定并分析其临床分布。结果62株鲍曼不动杆菌感染率高的有呼吸病房22例(35.5%),干部病房14例(22.6%),标本类型以痰为主52例(83.9%)。药敏监测该细菌对17种抗生素的耐药情况为亚胺培南、美洛培南、氨苄西林/舒巴坦、左氧氟沙星的敏感率较高,分别为100%、100%、75.8%、70.9%。有头孢唑林、氨苄西林、奥格门丁、氨曲南耐药率为90.3%、88.7%、80.6%、77.4%。结论鲍曼不动杆菌最有效的抗生素是亚胺培南、美洛培南,一旦临床发生感染,应及时调整和选用合理抗生素治疗,避免滥用抗生素,防止耐药菌株的产生,提高临床治愈率。     

金属离子铁和锌对鲍曼不动杆菌的抗菌作用机制研究进展

由于抗菌药物的开发周期越来越长,远远赶不上细菌耐药的发展速度,临床鲍曼不动杆菌多重耐药与泛耐药现象日益严重。因此,人们越来越关注对抗菌药物以外的抗菌物质的开发,尤其是从生存条件方面来研究抑制耐药菌活性的方法,如金、银、铜等金属离子对鲍曼不动杆菌的作用。本文主要综述铁、锌等金属离子及其螯合物对鲍曼不动杆菌的抗菌作用。铁、锌等金属离子通过与一系列酶的协同作用,调控外排泵或影响生物膜形成及其黏附性等来抑制细菌生长。此外,一些非必需金属如金、银、钯等对鲍曼不动杆菌也具有很强的毒性,有良好的抗菌和降低耐药率的效果,可作为医疗留置器械的抗菌涂层等来预防感染。