长沙地区临床分离金黄色葡萄球菌的耐药监测

目的了解长沙地区临床分离金黄色葡萄球菌（以下简称金葡菌）对常用抗菌药物的耐药现状,探讨金黄色葡萄球菌对甲氧西林的耐药水平。方法收集长沙地区11家医院2009年11月至2010年11月临床分离的非重复金葡菌279株,应用Vitek-2全自动微生物分析系统进行鉴定,K-B法检测金葡菌对24种药物的敏感性,产色头孢菌素试验检测β-内酰胺酶以及D试验检测诱导型克林霉素耐药。应用头孢西丁和苯唑西林纸片扩散法筛查耐甲氧西林的金葡菌（MRSA）,琼脂稀释法检测头孢西丁和苯唑西林的最低抑菌浓度（MIC）。结果在被检测的24种药物中,敏感率〉50%的药物为9种,未发现对万古霉素、替考拉宁和利奈唑胺耐药菌株;耐药率〉50%的抗菌药物有11种,其中以青霉素和氨苄西林的耐药率最高（均为97.1%）。MRSA的分离率达54.5%,且对常用的16种抗菌药物的耐药率均显著高于甲氧西林敏感金黄色葡萄球菌（MSSA）。279株金葡菌中,β-内酰胺酶阳性250株（89.6%）;红霉素耐药而克林霉素敏感或中介的30株中,D试验阳性22株（73.3%）。苯唑西林（OXA）和头孢西丁（FOX）MIC范围分别为0.125～〉256μg/mL和2～〉256μg/mL,苯唑西林的MIC50和MIC90分别为128μg/mL和256μg/mL,头孢西丁的MIC50和MIC90分别为64μg/mL和256μg/mL。结论长沙地区临床分离金葡菌对常用抗菌药物呈多重耐药;MRSA不仅分离率高,而且对甲氧西林呈高水平耐药。     

抗生素抗性基因在环境中的传播扩散及抗性研究方法

抗生素在医药、畜牧和水产养殖业的大量使用造成了环境中抗性耐药菌和抗性基因日益增加,抗生素抗性基因作为一种新型环境污染物引起人们的广泛关注.本文综述了近年来国内外有关抗生素抗性基因的研究进展,其在水、土壤、空气等环境介质中和动,植物体内的传播扩散,以及开展环境中抗生素抗性基因研究的必要性,重点介绍了有关抗生素抗性（包括抗性细菌和抗性基因）的研究方法,指出抗性基因研究中存在的问题,并对未来的相关研究进行了展望.     

A new look at antibiotic resistance

Abstract Since the discovery of antibiotic resistance in clinically important microbes, attention has focused properly on the profound medical aspects of this problem. However, studies of antibiotic resistance are of great interest in their own right for studies of gene regulation, evolution, chromosome structure, etc.; several resistance genes in clinical isolates are components of classical 'operon' structures. The construction of cloning vectors and gene transfer systems, particularly for interspecies studies, rely heavily on the use of antibiotic resistance genes, since these phenotypes can be used to select for DNA transfer between microbes, plants, and animals. Studies of the role of resistance mechanisms and their genetic determinants in antibiotic-producing organisms have shown that these functions play important roles in biosynthetic pathways and can provide important genetic and biochemical tools for the rational analysis of antibiotic production.     

2006年至2007年我院烧伤创面感染细菌及耐药性监测

目的了解近2年本所分离菌株和耐药情况。方法采用纸片扩散法（KB法）和采用CLSI2006年的判断标准对595株临床分离菌做药敏试验。结果595株细菌中G^-菌占61．51％,G^＋菌占36．3％;G^-球菌占0．84％,真菌占1．75％。发现铜绿假单胞菌对头孢曲松、头孢呋新、头孢塞肟和哌拉西林耐药率高达92．5％-99．1％,更甚者为鲍曼不动杆菌,对头孢唑啉、头孢曲松、头孢哌酮和丁胺卡那霉素耐药率均高达100％。变形杆菌和大肠埃希菌耐药性相对较低。结论烧伤感染常见菌为铜绿假单胞菌、鲍曼不动杆菌、变形杆菌和金葡菌,而且耐药性很强。     

环境中抗生素抗性基因的水平传播扩散

抗生素抗性基因作为一类新型环境污染物,其在不同环境介质中的传播扩散可能比抗生素本身的环境危害更大,其中,水平基因转移是抗生素抗性基因传播的重要方式,是造成抗性基因环境污染日益严重的原因之一.本文系统阐述了抗生素抗性基因在环境中发生水平转移的主要分子传播元件及其影响因素,这对于正确揭示抗性基因的分子传播机制具有重要意义.结合多重抗药性的传播扩散机制,探讨了行之有效的遏制抗生素抗性基因传播扩散的方法和途径,并针对目前的污染现状,对今后有关抗生素抗性基因水平转移的研究重点进行了展望.     

Antibiotic resistance as a tragedy of the commons: An ethical argument for a tax on antibiotic use in humans

To the extent that antibiotic resistance (ABR) is accelerated by antibiotic consumption and that it represents a serious public health emergency, it is imperative to drastically reduce antibiotic consumption, particularly in high‐income countries. I present the problem of ABR as an instance of the collective action problem known as ‘tragedy of the commons’. I propose that there is a strong ethical justification for taxing certain uses of antibiotics, namely when antibiotics are required to treat minor and self‐limiting infections, such as respiratory tract infections, in otherwise healthy individuals. Taxation would allow a reduction in consumption (given certain behavioural economics assumptions) and/or ensure that individuals internalize or compensate for their contribution to the erosion of the common good of antibiotic effectiveness. I suggest that revenue from the tax could be used to fund conservation and innovation strategies. Taxation might be a coercive policy, especially for certain individuals, but the ethical case for coercive policies is very strong when the good to be preserved is important enough and when they force individuals to do something they have a moral obligation to do anyway. I argue that, in the case of mild and self‐limiting infections, individuals have a moral duty of easy rescue and a moral duty of fairness to make their contribution to the preservation of the common good of antibiotic effectiveness by foregoing antibiotics. I also suggest that taxing antibiotics in such cases is an all things considered ethically justified policy even if it would introduce inequalities in access to healthcare.     

翻译后修饰与结核分枝杆菌耐药调控网络

目前对于结核分枝杆菌(Mycobacterium tuberculosis,Mtb)耐药产生机制研究得较多,但对其调控机制的研究较少。翻译后修饰(Post-translational modifications,PTMs)在结核菌多种生理途径(如代谢、应激反应等)中发挥重要调控作用,而它们和结核菌耐药之间的关系逐渐引起了研究者的关注。文中介绍了结核菌抗生素耐受机制以及存在的一些PTMs,重点讨论了PTMs在调控结核杆菌耐药机制中的潜在作用,以期为新型抗结核药物研发提供新的切入点。     

大熊猫源细菌耐药性研究进展

耐药菌和耐药基因已成为一种新型环境污染物,引发世界公共卫生问题。细菌耐药性尤其是多重耐药菌在人医临床、畜禽养殖以及环境传播等多个方面得到越来越多的关注,而关于大熊猫等野生动物的耐药性研究相对较少。大熊猫(Ailuropoda melanoleuca)是世界公认的珍稀野生动物,其种群数量易受到各种疾病的威胁,尤其是肠道细菌性疾病。随着抗菌药物在疾病预防和控制中的普遍使用,由此带来的耐药性危害日益明显。本文总结了关于大熊猫源细菌耐药的国内外研究报道,对其耐药表型、耐药基因型、耐药机制及水平传播机制等方面内容进行了综述,旨在为大熊猫源细菌耐药性的研究和防控提供依据,为临床科学用药提供理论参考,从而助力大熊猫迁地保护。     

抗生素耐药防控的One Health策略

抗生素耐药作为威胁公共卫生的巨大挑战已经制约了世界经济发展。我国抗生素使用量大,是世界上抗生素滥用最严重的国家之一。文中对人群、食用动物、环境中抗生素耐药产生的原因以及抗生素耐药现状进行综述,针对我国目前抗生素使用与耐药情况,从One Health理念提出了促进抗生素的科学使用、积极探索新型抗生素研发、建立抗生素立体监测网络系统、推广抗生素耐药教育、预防感染等措施,呼吁建立跨学科、跨部门、跨地域的交流与合作,推进我国抗生素耐药防控工作进一步开展,加强环境保护,维护人类与动物的共同健康。     

耐药基因数据库概述

抗生素是人类历史上的革命性发现,其临床应用挽救了无数患者的生命。但是随着抗生素的广泛使用和滥用,越来越多的病原菌产生了耐药性,甚至出现了具有多重耐药性的"超级细菌"。在人类与病原菌斗争的军备竞赛中,人类即将面临无药可用的境地。针对微生物的耐药性、耐药机制及耐药性传播的研究吸引了众多科研工作者的目光,各种耐药基因数据库以及耐药基因分析工具应运而生。文中对目前耐药领域的基因数据库进行收集整理,从数据库类型、数据特征、耐药基因预测模型以及可分析序列的类型等方面对这些数据库进行论述和介绍。此外,文中对抗金属离子和抗杀菌剂的基因数据库也有所涉及,将为如何选择及使用耐药基因数据库提供参考和帮助。     

基于基因组数据分析的细菌耐药基因识别与表型预测

利用基因组数据和生物信息学分析方法,快速鉴定耐药基因并预测耐药表型,为细菌耐药状况监测提供了有力辅助手段。目前,已有的数十个耐药数据库及其相关分析工具这些资源为细菌耐药基因的识别以及耐药表型的预测提供了数据信息和技术手段。随着细菌基因组数据的持续增加以及耐药表型数据的不断积累,大数据和机器学习能够更好地建立耐药表型与基因组信息之间的相关性,因此,构建高效的耐药表型预测模型成为研究热点。本文围绕细菌耐药基因的识别和耐药表型的预测,针对耐药相关数据库、耐药特征识别理论与方法、耐药数据的机器学习与表型预测等方面展开讨论,以期为细菌耐药的相关研究提供手段和思路。     

Ecogenetics of antibiotic resistance in Listeria monocytogenes

The acquisition process of antibiotic resistance in an otherwise susceptible organism is shaped by the ecology of the species. Unlike other relevant human pathogens, Listeria monocytogenes has maintained a high rate of susceptibility to the antibiotics used for decades to treat human and animal infections. However, L. monocytogenes can acquire antibiotic resistance genes from other organisms’ plasmids and conjugative transposons. Ecological factors could account for its susceptibility. L. monocytogenes is ubiquitous in nature, most frequently including reservoirs unexposed to antibiotics, including intracellular sanctuaries. L. monocytogenes has a remarkably closed genome, reflecting limited community interactions, small population sizes and high niche specialization. The L. monocytogenes species is divided into variants that are specialized in small specific niches, which reduces the possibility of coexistence with potential donors of antibiotic resistance. Interactions with potential donors are also hampered by interspecies antagonism. However, occasional increases in population sizes (and thus the possibility of acquiring antibiotic resistance) can derive from selection of the species based on intrinsic or acquired resistance to antibiotics, biocides, heavy metals or by a natural tolerance to extreme conditions. High-quality surveillance of the emergence of resistance to the key drugs used in primary therapy is mandatory.     

Bacteriophage-mediated transduction of antibiotic resistance in enterococci

Aims: Temperate bacteriophages are bacterial viruses that transfer genetic information between bacteria. This phenomenon is known as transduction, and it is important in acquisition of bacterial virulence genes and antimicrobial resistance determinants. The aim of this study was to demonstrate the role of bacteriophages in gene transfer (antibiotic resistance) in enterococci. Methods and Results: Three bacteriophages from environmental samples isolated on pig host strains of Enterococcus gallinarum and Enterococcus faecalis were evaluated in transduction experiments. Antibiotic resistance was transferred from Ent. gallinarum to Ent. faecalis (tetracycline resistance) and from Ent. faecalis to Enterococcus faecium, Enterococcus hirae/durans and Enterococcus casseliflavus (gentamicin resistance). Conclusions: Bacteriophages play a role in transfer of antibiotic resistance determinants in enterococci. Significance and Impact of the Study: This study confirms previous suggestions on transduction in enterococci, in particular on interspecies transduction. Interspecies transduction is significant because it widens the range of recipients involved in antimicrobial resistance transfer.     

Inequality and antibiotic resistance: A contractualist perspective

There are substantial inequalities associated with antibiotics and the determinants of their effectiveness, including the risk of exposure to antibiotic‐resistant microbes, access to relevant treatment advice, diagnostic facilities, risk of life‐threatening infectious disease, and access to antibiotics. Current arrangements (social, political, economic) allow inequalities in the distribution of antibiotic benefits and burdens. This article focuses on the justification of relevant inequalities from a contractualist perspective.     

A global view of antibiotic resistance

Antibiotic resistance is one of the few examples of evolution that can be addressed experimentally. The present review analyses this resistance, focusing on the networks that regulate its acquisition and its effect on bacterial physiology. It is widely accepted that antibiotics and antibiotic resistance genes play fundamental ecological roles – as weapons and shields, respectively – in shaping the structures of microbial communities. Although this Darwinian view of the role of antibiotics is still valid, recent work indicates that antibiotics and resistance mechanisms may play other ecological roles and strongly influence bacterial physiology. The expression of antibiotic resistance determinants must therefore be tightly regulated and their activity forms part of global metabolic networks. In addition, certain bacterial modes of life can trigger transient phenotypic antibiotic resistance under some circumstances. Understanding resistance thus requires the analysis of the regulatory networks controlling bacterial evolvability, the physiological webs affected and the metabolic rewiring it incurs.     

转基因植物中抗生素抗性基因的安全性评价

20世纪80年代以来,植物转基因技术取得突飞猛进的进展。转基因植物大量出现,带来了巨大的经济效益和社会效益。与此同时,转基因植物的释放可能带来的风险也越来越受到人们的重视,抗生素抗性基因是筛选转基因植物的常用基因,其安全性引起了人们的普遍关注,作者就转基因植物中抗生素抗性基因的安全性作一综述。     

Evolution and ecology of antibiotic resistance genes

A new perspective on the topic of antibiotic resistance is beginning to emerge based on a broader evolutionary and ecological understanding rather than from the traditional boundaries of clinical research of antibiotic-resistant bacterial pathogens. Phylogenetic insights into the evolution and diversity of several antibiotic resistance genes suggest that at least some of these genes have a long evolutionary history of diversification that began well before the 'antibiotic era'. Besides, there is no indication that lateral gene transfer from antibiotic-producing bacteria has played any significant role in shaping the pool of antibiotic resistance genes in clinically relevant and commensal bacteria. Most likely, the primary antibiotic resistance gene pool originated and diversified within the environmental bacterial communities, from which the genes were mobilized and penetrated into taxonomically and ecologically distant bacterial populations, including pathogens. Dissemination and penetration of antibiotic resistance genes from antibiotic producers were less significant and essentially limited to other high G+C bacteria. Besides direct selection by antibiotics, there is a number of other factors that may contribute to dissemination and maintenance of antibiotic resistance genes in bacterial populations.