生物被膜肺炎克雷伯菌产ESBLs的耐药性和基因型分析

目的检测临床分离的肺炎克雷伯菌在体外形成生物被膜后产超广谱β-内酰胺酶（Extended-Spectrum β-Laetamases,ESBLs）的情况,分析及研究其耐药性和耐药基因的分型情况。方法采用改良平板法在体外建立肺炎克雷伯菌生物被膜模型,用三维试验确认产ESBLs菌株,用K-B法进行药敏试验,用聚合酶链反应（Polymerase chain reaction,PCR）进行blaSHV、blaTEM和blaCTX—M基因扩增,产物分别克隆人pMD18-T载体后测定其核苷酸序列,分析其基因亚型。结果临床筛选出的60株ESBLs阴性肺炎克雷伯菌有46株在体外成功建立了生物被膜模型,并有9株产生了ESBLs表型。产酶后菌株的耐药性明显高于产酶前。PCR结果显示9株细菌均携带SHV基因,有4株同时携带TEM基因,没有检出携带CTX-M基因的菌株。9株细菌的SHV基因分别属于SHV-5、SHV-12和SHV-28亚型。4株携带TEM基因的细菌均为TEM-1亚型。结论生物被膜的形成能够诱导肺炎克雷伯菌产生ESBLs。本实验中检出的产ESBLs的基因型都是由SHV-1突变产生的。生物被膜的形成和产生ESBLs的协同作用是生物被膜肺炎克雷伯菌耐药性增强的主要原因之一。     

大熊猫源肺炎克雷伯菌生物学特性

【背景】肺炎克雷伯菌是仅次于大肠杆菌的常见条件致病菌之一,严重时可导致大熊猫发生出血性肠炎、全身性败血症等。【目的】明确大熊猫源肺炎克雷伯菌的生物学特性,对防控该病作出科学指导。【方法】分别采用结晶紫染色法、拉丝实验、K-B纸片法和PCR技术对46株大熊猫源肺炎克雷伯菌的生物被膜形成能力、高黏性表型、耐药表型和15种常见毒力基因等生物学特性进行研究,并根据以上生物学特性选择一株可能具有致病性的分离菌pneumoniae-X-5,研究其对小鼠的致病性。【结果】46株肺炎克雷伯菌均可形成荚膜;12株为高黏性表型肺炎克雷伯菌;能形成生物被膜的菌株占比为65%(30/46);分离出的46株菌中多重耐药菌株占58%(27/46),对氨苄西林、苯唑西林、青霉素、万古霉素呈100%耐药;毒力基因检出率最高的为ureA(91.30%,42/46)。pneumoniae-X-5菌株对小鼠的LD₅₀为8.9×10⁴CFU/mL;该菌株攻毒小鼠肺泡间隔增厚,炎性细胞浸润,肝细胞变性坏死,脾充血,十二指肠黏膜上皮和固有层分离,固有层部分细胞坏死。死亡小鼠脾脏含细菌量最多,其次为肝脏。【结论】本试验阐明了部分大熊猫源肺炎克雷伯菌的多重耐药性、能形成生物被膜、具有高黏表型等病原生物学特性,为大熊猫肺炎克雷伯杆菌病的防控及临床治疗提供了科学依据。     

大肠埃希菌生物被膜体外模型的建立及黄连水提物对其抑制作用的初步研究

建立大肠埃希菌生物被膜（biofilm,BF）在Ф30培养皿和96孔板表面形成的体外模型,并开展黄连水煎液对BF抑制作用的初步研究。选取临床分离的大肠埃希菌菌株,在Ф30培养皿中采用LB（Luria-Bertani medium）培养基系统复制体外BF模型,经银染后利用显微摄影系统观察BF形态;在96孔板中采用LB培养基系统复制体外BF模型,采用MTT法利用酶标仪测定OD值。将黄连水煎液作用于大肠埃希菌生物被膜体外模型,分别采用MTT法和银染法考察黄连水提物对大肠埃希菌生物被膜的影响。Ф30培养皿表面可以观察到黑染呈棉絮状的膜样物而空白组没有此样物质;96孔板中,模型组的OD值为4．191,空白组的OD值为0．069;药物作用24h后黄连组的BF明显少于空白对照组;80mg／mL的黄连水煎液即开始对大肠埃希菌生物被膜有抑制作用,抑制率为20．8％,生药浓度达到180mg／mL时为最佳抑制浓度,抑制率为70．23％。Ф30培养皿和96孔板表面可以形成大肠埃希菌生物被膜,黄连水煎液可以抑制和破坏早期及成熟BF,且其抑制作用表现出了一定的量效关系,此方法对黄连水煎液作用于大肠埃希菌生物被膜是可行且稳定的,为应用于临床试验奠定基础。     

绿原酸联合左氧氟沙星对肺炎克雷伯菌生物膜的体外抑制现象观察

目的观察绿原酸联合左氧氟沙星对肺炎克雷伯菌生物膜的体外抑制现象。方法收集广州市中医医院临床分离的肺炎克雷伯菌株(排除同一患者同一部位重复菌株),应用半定量结晶紫法进行生物膜形成能力测定;选取3株生物膜强阳性的菌株,采用微量肉汤稀释法,对绿原酸、左氧氟沙星用MH肉汤倍比稀释,测定两者的最低抑菌浓度;棋盘稀释法测定绿原酸与左氧氟沙星的协同抑菌浓度;建立体外生物膜模型,经药物干扰,观察药物对生物膜形态的影响。结果在62株菌中共有33株为生物膜阳性,占53.2%,绿原酸对实验菌株的MIC分别是2 048、2 048和2 048μg/mL,左氧氟沙星的MIC分别是32、64和32μg/mL,两药联合作用,部分抑菌浓度指数(FIC)是0.5、0.5和0.5,提示两药呈协同作用,经体外建模及药物干扰,镜下药物组的黑色絮状物较未处理组明显减少。结论绿原酸具有抑制肺炎克雷伯菌生物膜作用,与左氧氟沙星联合,作用效果更显著。     

银染法观察铜绿假单胞菌生物被膜

目的 评估银染法鉴定铜绿假单胞菌生物被膜的效果.方法 体外平板法制备铜绿假单胞菌生物被膜模型,用银染法观察鉴定.结果 银染后普通光学显微镜和扫描电镜观察铜绿假单胞菌生物被膜.结论 银染法鉴定铜绿假单胞菌生物被膜简单可靠.     

肺炎克雷伯菌在儿科各病房的临床分布及耐药性分析

目的了解肺炎克雷伯菌在儿科普通病房、新生儿病房、小儿重症监护病房(PICU)的临床分布特点和耐药情况,为临床合理用药提供依据。方法对本院2011年1月1日至2015年12月31日儿科各病房采集到的标本进行分析,菌株鉴定采用法国生物梅里埃公司的VITEK 2COMPACT分析仪,药敏试验采用MIC法。结果本院儿科各病房共分离到487株肺炎克雷伯菌,主要来自痰液和鼻咽拭子;各病区中产ESBLs的肺炎克雷伯菌检出率在35.3%~42.7%之间。药敏结果显示,产ESBLs肺炎克雷伯菌对氨苄西林、头孢菌素类、氨曲南100%耐药,对碳青霉烯类、氨基糖甙类、喹诺酮类抗菌药物敏感;未产ESBLs菌株耐药率相对较低。结论加强肺炎克雷伯菌的分离鉴定及耐药性的测定,是临床合理应用抗生素的重要依据。     

肺炎克雷伯菌临床分离株的庆大霉素耐药性和细菌铁载体的作用

目的 研究临床分离的肺炎克雷伯菌对氨基糖苷类抗生素庆大霉素的耐药性与其产铁载体的关系。方法 采用K-B纸片法和肉汤稀释法确定70株临床分离的肺炎克雷伯菌对庆大霉素的药物敏感性;CAS琼脂实验检测肺炎克雷伯菌是否产铁载体;紫外可见分光光度法确定细菌产铁载体的量,根据中位数法将70株临床分离菌分为铁载体高产组（35株）和低产组（35株）;应用SPSS统计学软件分析抗生素耐药性与其产铁载体是否相关。结果 药物敏感性试验检测出菌株对庆大霉素的耐药率为50.00%（35/70）;铁载体检测实验确定70株肺炎克雷伯菌均产生铁载体,肺炎克雷伯菌对庆大霉素的耐药性与铁载体产量呈正相关关系（r=0.3154,P<0.05）,对庆大霉素耐药菌株铁载体产量明显高于敏感菌株（t=3.1650,P<0.05）,且铁载体高产组耐药率及lgMIC值明显高于低产组（χ2=9.6570,t=3.1360,P<0.05）。结论 70株临床分离的肺炎克雷伯菌均产生铁载体,铁载体可能参与肺炎克雷伯菌对庆大霉素的耐药,干扰庆大霉素的抑菌或杀菌过程。     

肺炎克雷伯菌生物被膜豚鼠肺感染模型建立的实验研究

目的采用吸入法建立肺炎克雷伯菌生物被膜（BF）肺感染模型,探讨肺内肺炎克雷伯菌BF的发生发展变化及其BF菌周围炎性细胞的变化。方法40只豚鼠随机分为两组：A组和B组动物分别通过喷雾器接种灭菌生理盐水及肺炎克雷伯菌菌悬液,取材日进行活菌计数、光学及电子显微镜检查。结果肺炎克雷伯菌BF在肺内以特异的肉芽肿结节的形式存在,有体内炎性细胞的参与。扫描电镜可见结节内有多糖蛋白复合物包绕的细菌,菌体之间相互以粘液丝相连。结论吸入法BF肺感染模型方法简单、重复性好,可用于BF菌相关肺感染的研究。     

桑螵蛸挥发油对金黄色葡萄球菌生物被膜形成的体外抑制效应的初步探究CSCD

目的研究桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜形成的体外抑制效应。方法采用六孔板为载体培养细菌生物被膜,在刚果红平板鉴定使用的金黄色葡萄球菌菌株为生物被膜阳性菌株的基础上,再采用银染后通过倒置显微镜观察法来观察桑螵蛸挥发油提取物及其他药物对金黄色葡萄球菌生物被膜形成的体外抑制效应。结果空白对照组细菌生物被膜明显,药物实验组细菌生物被膜受到抑制,且桑螵蛸挥发油实验组抑制效果最明显。结论桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜的形成有明显的抑制效应,为下一步研究其详细有效成分及开发提供基础数据和理论依据。     

桑螵蛸挥发油对金黄色葡萄球菌生物被膜形成的体外抑制效应的初步探究

目的研究桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜形成的体外抑制效应。方法采用六孔板为载体培养细菌生物被膜,在刚果红平板鉴定使用的金黄色葡萄球菌菌株为生物被膜阳性菌株的基础上,再采用银染后通过倒置显微镜观察法来观察桑螵蛸挥发油提取物及其他药物对金黄色葡萄球菌生物被膜形成的体外抑制效应。结果空白对照组细菌生物被膜明显,药物实验组细菌生物被膜受到抑制,且桑螵蛸挥发油实验组抑制效果最明显。结论桑螵蛸挥发油提取物对金黄色葡萄球菌生物被膜的形成有明显的抑制效应,为下一步研究其详细有效成分及开发提供基础数据和理论依据。     

肺炎克雷伯菌KP1＿4563基因突变株的构建及其生物膜表型分析

KP1_4563基因是肺炎克雷伯菌NTUH-K2044中假设的蛋白编码基因,与Ⅲ型菌毛的功能有关。本实验首先采用同源重组基因敲除方法构建肺炎克雷伯菌KP1_4563基因缺失的突变株(Kp-△4563),然后PCR扩增KP1_4563基因片段,克隆到质粒p BAD33上,将重组质粒导入Kp-△4563获得回补株(Kpc-△4563)。分别测定野生株、突变株、回补株用普通LB培养基,改良Minka培养基以及含胆汁盐的LB培养基培养时生物膜形成能力,以此来探讨KP1_4563基因以及不同培养基对肺炎克雷伯菌体外生物膜形成的影响。我们成功构建KP1_4563基因缺失的突变株和回补株Kpc-△4563。与野生株相比,突变株Kp-△4563生物膜形成能力减弱,回补株介于野生株和突变株之间。使用改良Minka培养基使菌株菌毛化以及加入胆汁盐可以增加生物膜的形成能力。这些分析表明肺炎克雷伯菌KP1_4563基因能正调控细菌生物膜的形成。体外培养使细菌菌毛化以及加入胆汁盐可以促进生物膜的形成。     

Biofilm density and detection of biofilm-producing genes in methicillin-resistant Staphylococcus aureus strains

Many serious diseases caused by Staphylococcus aureus appear to be associated with biofilms. Therefore, we investigated the biofilm-forming ability of the methicillin-resistant S. aureus (MRSA) isolates collected from hospitalized patients. As many as 96?% strains had the ability to form biofilm in vitro. The majority of S. aureus strains formed biofilm in ica-dependent mechanism. However, 23?% of MRSA isolates formed biofilm in ica-independent mechanism. Half of these strains carried fnbB genes encoding surface proteins fibronectin-binding protein B involved in intercellular accumulation and biofilm development in S. aureus strains. The biofilm structures were examined via confocal laser scanning microscopy (CLSM) and three-dimensional structures were reconstructed. The images obtained in CLSM revealed that the biofilm created by ica-positive strains was different from biofilm formed by ica-negative strains. The MRSA population showed a large genetic diversity and we did not find a single clone that occurred preferentially in hospital environment. Our results demonstrated the variation in genes encoding adhesins for the host matrix proteins (elastin, laminin, collagen, fibronectin, and fibrinogen) and in the gene involved in biofilm formation (icaA) within the majority of S. aureus clones.     

Effects of a topical essential oil-containing formulation on biofilm-forming coagulase-negative staphylococci

AIMS: To evaluate the antimicrobial effects of Polytoxinol (PT), a topical essential oil-based formulation, against biofilm positive strains of coagulase-negative staphylococci. METHODS AND RESULTS: Using a microtitre plate assay we measured inhibitory effects for PT against a selection of biofilm-forming clinical isolates of coagulase-negative staphylococci. Susceptibility varied considerably (MIC = 0.6-20 000 ppm). For the most tolerant clinical isolate (Staphylococcus warneri) biofilm growth was inhibited by a 32-fold lower PT concentration than planktonic growth. This inhibition of biofilm development, which was not observed with the other test isolates, was related to an inhibition of the initial phase of S. warneri cell adherence to the polystyrene surface. CONCLUSION: The antimicrobial efficacy of PT was verified against clinical isolates of coagulase-negative staphylococci in vitro. PT was able to inhibit biofilm formation in the most tolerant isolate at sub-inhibitory concentrations. SIGNIFICANCE AND IMPACT OF THE STUDY: These observations indicate that an ability to prevent biofilm formation, independently of effects on cell viability may contribute to the in vivo topical efficacy of essential oils.     

A Widely Used In Vitro Biofilm Assay Has Questionable Clinical Significance for Enterococcal Endocarditis

Biofilm formation may play an important role in the pathogenesis of infections caused by Enterococcus faecalis, including endocarditis. Most biofilm studies use a polystyrene dish assay to quantify biofilm biomass. However, recent studies of E. faecalis strains in tissue and animal models suggest that polystyrene dish results need to be interpreted with caution. We evaluated 158 clinical E. faecalis isolates using a polystyrene dish assay and found variation in biofilm formation, with many isolates forming little biofilm even when different types of media were used. However, all tested clinical isolates were able to form biofilms on porcine heart valve explants. Dextrose-enhanced biofilm formation in the polystyrene dish assay was found in 6/12 (50%) of clinical isolates tested and may explain some, but not all of the differences between the polystyrene dish assay and the heart valve assay. These findings suggest that in studies assessing the clinical relevance of enterococcal biofilm-forming ability, ex vivo biofilm formation on a relevant tissue surface may be warranted to validate results of in vitro assays.     

Evaluation of the biofilm-forming ability and genetic typing for clinical isolates of Pseudomonas aeruginosa by enterobacterial repetitive intergenic consensus-based PCR

Biofilm formation is an important phenotype associated with chronic Pseudomonas aeruginosa infections. In the present study, a total of 48 P. aeruginosa strains isolated from clinical specimens were examined for their biofilm-forming ability using a microtiter plate method. The different biofilm-forming abilities were demonstrated among the strains; however, most strains formed a larger biofilm than strain PAO1, a reference strain. The genetic typing was also carried out by enterobacterial repetitive intergenic consensus-based polymerase chain reaction. Although they were divided into five groups (A to E), most of the strains showing the higher biofilm-forming ability were found to be in groups D and E, suggesting a significant relationship between the biofilm-forming ability and the genetic group.     

Biofilm formation and cell-to-cell signalling in Gram-negative bacteria isolated from a food processing environment

AIMS: To investigate the biofilm-forming capacity and the production of quorum signals in Gram-negative bacteria isolated from a food production environment, and the possible correlation between both phenotypes. METHODS AND RESULTS: Sixty-eight Gram-negative bacteria were isolated from equipment and working surfaces in a raw vegetable processing line, and tested for biofilm-forming capacity using an in vitro microplate assay. All isolates showed significantly higher biofilm-forming capacity than Escherichia coli laboratory strain DH5alpha, which was included as a negative control, and differed up to 56-fold in relative biofilm-forming capacity. Various assays based on reporter bacteria were used to detect quorum signals produced by the isolates. Twenty-six isolates produced autoinducer-2, five isolates produced N-acyl-homoserine lactones (AHLs), and none produced the Pseudomonas quinolone signal. CONCLUSIONS: No correlation was found between in vitro biofilm-forming capacity and production of quorum signalling molecules among the 68 strains isolated from the raw vegetable processing line. SIGNIFICANCE AND IMPACT OF THE STUDY: Several recent studies have shown a role of AHL-based quorum sensing in biofilm formation of specific Gram-negative bacterial strains. The current work shows that production of AHL and other quorum signals is not widespread in Gram-negative isolates from a raw vegetable processing line, and is not a general requirement for biofilm formation, at least in vitro.     

上海市某三甲医院幽门螺杆菌耐药性和毒力与其生物膜形成能力的相关性研究

为探讨复旦大学附属华东医院(以下简称本院)分离培养的幽门螺杆菌(Helicobacter pylori,H. pylori)的耐药性、毒力和感染特征与其生物膜形成能力的相关性,收集2014年12月-2015年6月于本院消化内镜中心的胃活检组织标本及相应临床病例资料,分离培养获得幽门螺杆菌,分析菌株的耐药性、毒力基因型、临床病例特征。结果显示,从胃活检组织样本中共分离培养28株幽门螺杆菌,对左氧氟沙星(levofloxacin,LEV)、甲硝唑(metronidazole,MTZ)和克拉霉素(clarithromycin,CLA)的耐药率分别为32%、75%和11%,未发现阿莫西林(amoxicillin,AMX)耐药。单一药物耐药17株(17/28,61%),双重耐药10株(10/28,36%)。毒力基因cagA、oipA和vacAs1检出率为100%,未检出vacAs2。基因型vacAs1m1占39%(11/28),vacAs1m2占61%(17/28);iceA1占54%(15/28),iceA2占21%(6/28),iceA1A2占25%(7/28);dupA^＋占36%(10/28)。28株菌株均能形成生物膜,但能力不尽相同。单因素及独立样本t检验分析显示,45～59岁、iceA1^＋dupA^－基因型和甲硝唑敏感菌株形成生物膜的能力较强。结果提示,本院分离的幽门螺杆菌对甲硝唑耐药率最高,双重耐药不容忽视。菌株主要毒力基因型为cagA、oipA、vacAs1m2。幽门螺杆菌的生物膜形成能力与患者年龄有关,45～59岁组较强;携带毒力基因iceA1的菌株生物膜形成能力强;dupA基因型及甲硝唑耐药与菌株生物膜形成呈负相关。     

长沙某医院产质粒AmpC酶型肺炎克雷伯菌的多重PCR检测与分析

为了了解湖南长沙某医院临床分离的肺炎克雷伯菌中质粒介导AmpC β-内酰胺酶的产生情况及其基因型,收集了该医院2008年3月至2010年10月临床分离的多重耐药肺炎克雷伯菌104株,用头孢西丁纸片扩散法对这些菌株进行表型初筛,用多重PCR确定ampC耐药基因型;结果发现其中有19株对头孢西丁纸片不敏感,疑为产AmpC酶菌株;再经多重PCR扩增,有12株菌分别在约400 bp（11株）和约350 bp（1株）出现了阳性条带,特异性PCR证明此12株菌分别携带了DHA型（11株）和ACC型（1株）ampC耐药基因;产质粒介导AmpC酶肺炎克雷伯菌的分离率为11.5%（12/104）。该医院产质粒介导AmpC酶肺炎克雷伯菌的分离率较高,应对其检测与监测给予足够重视,以指导临床合理选用抗菌药物。