产超广谱β-内酰胺酶细菌中I类整合子的研究进展

产超广谱β-内酰胺酶(Extended-spectrum beta-lactamase, ESBLs)细菌的多重耐药性是临床用药的一大难题, 近年研究发现其耐药性的产生与整合子密切相关, 其中临床最常见、研究最深入的是I类整合子。整合子是一种可移动基因元件, 在整合酶的作用下捕捉外源基因盒并使之表达, 是具有基因整合和切除功能的天然克隆和表达系统。研究表明I类整合子可连续捕捉和整合多种耐药基因, 以质粒或转座子为载体在细菌之间传播耐药性, 使ESBLs细菌多重耐药趋势十分严峻。本文就I类整合子的结构特征、I类整合子对耐药基因盒的整合作用及其与ESBLs细菌耐药性的关系等方面进行综述。     

ChromID ESBL选择性显色平板对产ESBLs肠杆菌科细菌筛选效果的评价

目的 评价ChromID ESBL选择性显色平板对产超广谱β-内酰胺酶（ESBLs）肠杆菌科细菌的筛选效果。方法 选取临床分离的371株肠杆菌科细菌进行ESBLs的检测,用ChromID ESBL选择性显色平板做筛选试验,同时用纸片确证法做确证试验,采用Kappa检验对两者结果进行一致性分析。结果 两种方法对371株肠杆菌科细菌ESBLs检测的总Kappa值为0.761。ChromID ESBL选择性显色平板法的总灵敏度为95.2%,总特异度为83.5%。对大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌分别统计,其Kappa值分别为0.832、0.514、0.778;ChromID ESBL选择性显色平板法对其检测灵敏度分别为95.7%、91.3%、100.0%,特异度分别87.6%、72.9%、90.9%。另外有6株大肠埃希菌在该显色平板上显非特征色。结论 ChromID ESBL选择性显色平板对产ESBLs肠杆菌科细菌的筛选效果与纸片确证法总体一致性较好,其灵敏度和特异度较高,可应用于临床。但该显色平板对产ESBLs肺炎克雷伯菌的筛选效果与纸片确证法一致性一般,其特异度也较低;对大肠埃希菌存在一定的假阴性,对于该显色平板上生长的绿色和白色菌落需要做进一步鉴定确认。     

Activities of the frog skin peptide, ascaphin-8 and its lysine-substituted analogs against clinical isolates of extended-spectrum beta-lactamase (ESBL) producing bacteria

Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are becoming increasingly prevalent and their antibiotic resistance necessitates novel therapeutic intervention. Ascaphin-8 is a cationic alpha-helical peptide that shows broad-spectrum antibacterial activity but is also toxic to human erythrocytes (LC(50)= 55 microM). This study assesses the activity of ascaphin-8, and a series of l-lysine-substituted analogs, against a range of clinical isolates of ESBL-producing bacteria. All ESBL-producing Escherichia coli (MIC=1.5-6 microM) and Klebsiella pneumoniae (MIC=12.5-25 microM) strains tested were susceptible to ascaphin-8, as well as a group of miscellaneous ESBL-producing strains (Citrobacter, Salmonella, Serratia, Shigella spp.) (MIC< or = 25 microM). The Lys4- and Lys8-substituted analogs were generally the most potent against bacteria but showed the highest hemolytic activity. However, the Lys10, Lys14, and Lys18 analogs also displayed potent antibacterial activity while showing very low hemolytic activity (LC50> 500 microM). An unexpected finding was the susceptibility of ESBL-producing Proteus mirabilis strains to ascaphin-8 (MIC=12.5-25 microM) and its Lys4-substituted analog (MIC= 6 microM), although non-ESBL isolates of this organism were resistant to these peptides (MIC> 100 microM).     

An IS1-like element is responsible for high-level synthesis of extended-spectrum beta-lactamase TEM-6 in Enterobacteriaceae.

Resistance of Escherichia coli strain HB251 to the newer beta-lactam antibiotics, in particular ceftazidime and aztreonam, results from production of the extended-spectrum beta-lactamase TEM-6. The corresponding structural gene, bla(T)-6, and its promoter region were amplified by the polymerase chain reaction. Analysis of the sequence of the amplification product showed that bla(T)-6 differed by two nucleotide substitutions from bla(T)-1, the gene encoding TEM-1 penicillinase in plasmid pBR322. The mutations led to the substitution of a lysine for a glutamic acid at position 102 and of a histidine for an arginine at position 162 of the unprocessed TEM-1 protein. The presence of a 116 bp DNA insert upstream from bla(T)-6 resulted in the creation of hybrid promoter P6 in which the -10 region was that of TEM-1 promoter P3 whereas the -35 canonical sequence TTGACA was provided by the right end of the insert. P6 was found to be 10 times more active than P3 and to confer higher levels of antibiotic resistance upon the host. Analysis of the sequence of the insert indicated that the 116 bp fragment is related to insertion sequence IS1 but differs from it by three internal deletions that removed regions encoding the transposase. The distribution of the IS1-like element in clinical isolates of Enterobacteriaceae was studied by the polymerase chain reaction and by DNA-DNA hybridization. The element appeared to be widespread and was detected in strains producing TEM-6 or other TEM variants.     

Extended spectrum beta-lactamase producing Enterobacteriaceae in Lebanese ICU patients: epidemiology and patterns of resistance

Our study aims to investigate and describe the epidemiology of the intestinal carriage of ESBL-PS in intensive care units of five Lebanese hospitals and to analyze the potential risk factors for the acquisition of these strains. At the same time, we intend to determine the patterns of susceptibility of these strains, exploring therefore the availability of alternative treatment. One thousand, four hundred forty-two fecal samples were collected between January 1, 2003 and March 31, 2003 from 378 patients admitted to the ICUs of five Lebanese tertiary care general hospitals located in different areas of Lebanon. ESBL production was detected by the double disk synergy test and antibiotic susceptibility of ESBL-producing strains as well as minimum inhibitory concentrations were determined. A paired case-control study was undertaken to identify risk factors for carriage of ESBL-PS. One hundred eighteen strains isolated from 72 subjects were identified as ESBL producers, including 95 (80.5%) E. coli, 16 (13.6%) Klebsiella pneumoniae, and 7 (5.6%) Enterobacter cloacae. A higher rate of multiple ESBL-PS carriage was described among these acquisition cases (21 double carriages and 3 triple carriages of ESBL-PS compared to only 1 double carriage of ESBL-PS at admission). In general, similar trends of susceptibility were observed in the different hospitals. As expected, the lowest MIC was observed with imipenem for all E. coli, Klebsiella, and Enterobacter isolates. Ciprofloxacin, followed by trimethoprim-sulfamethoxazole seem to be associated with the lowest susceptibility. In vitro susceptibility to cefoxitin for all isolates was 74.6%; more resistance was associated to ceftazidime (90.7%) than to cefotaxime (69.7%). Our data agree with other national and international reports showing the increase in ESBL-PS carriage in ICU patients. They demonstrate the endemic character of this carriage in Lebanese hospitals and the important risk factors including immunosuppression and evidence of ESBL infection. The highly resistant profile of ESBL-PS to antimicrobial agents available for treatment reflects the severity of this issue. The significance of this study resides in the direct correlation between our results and the nationwide increase in multi-drug resistant bacteria and the continuous change in bacterial resistance epidemiology. Our data may have an important impact on infection control policies in hospitals and on treatment of infectious diseases.     

Prevalence of extended-spectrum beta-lactamases produced by nosocomial isolates of Enterobacteriaceae in Trakya University Hospital,Turkey

The prevalence of extended-spectrum beta-lactamase (ESBL) production by 194 nosocomial isolates of Enterobacteriacea recovered from 1995 to 1999 was investigated. The ESBL production was determined by the double-disk synergy test and was confirmed by the E-test ESBL strip. Twenty-three isolates (21 Klebsiella pneumoniae, one Escherichia coli, one Providencia rettgeri) were found as ESBL-producers (11.8%). These isolates were also usually resistant to non-betalactam antibiotics. Most of them contained a beta-lactamase with a pI of 7.6. All the strains conjugally transferred their ESBLs to recipient E. coli. Contrary to others, ESBL-producing K. pneumoniae strains isolated in 1999 were resistant to ciprofloxacin, and had the identical plasmid profiles suggestive of an outbreak. Ciprofloxacin resistance in these strains could not be transferred. In conclusion, K. pneumoniae was the main ESBL-producing species among nosocomial isolates of Enterobacteriacae in our hospital.     

First Initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms

We report the first case of extended-spectrum beta-lactamase producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms. Because of the acute aneurysm expansion with possible impending rupture on 2 abdominal CT scan, the patient underwent prompt vascular surgery and broad spectrum antibiotic therapy but he died of a hemorrhagic shock. Extended-spectrum beta-lactamase producing E. coli was identified from both blood and cerebrospinal fluid culture before vascular treatment. The present case report does not however change the guidelines of Gram negative bacteria meningitis in adults.     

不动杆菌产AmpC酶和超广谱β-内酰胺酶调查

目的了解不动杆菌属产AmpC酶和超广谱β-内酰胺酶(ESBLs)的情况及耐药分析。方法用K-B琼脂扩散法进行药敏试验,三维试验检测不动杆菌属产生的AmpC酶和ESBLs。结果169株不动杆菌,产ESBLs 43株(25.6%),产AmpC酶41株(24.4%),同时产超广谱β-内酰胺酶和AmpC酶10株(5.8%);产AmpC酶的菌株耐药情况比产ESBLs的菌株严重。结论不动杆菌属产AmpC酶和ESBLs的比例较高,应合理使用抗生素,才能有效控制感染。     

Application of bacteriophages in simultaneously controlling Escherichia coli O157:H7 and extended-spectrum beta-lactamase producing Escherichia coli

Applied Microbiology and Biotechnology - Shiga toxin-producing Escherichia coli (STEC) O157:H7 and extended-spectrum beta-lactamase (ESBL) producing E. coli (ESBLEC) are important bacteria of...     

Characterization of an extended-spectrum class C beta-lactamase of Citrobacter freundii

Citrobacter freundii GC3 is a clinical isolate which showed moderate resistance to oxyimino beta-lactams such as ceftazidime and aztreonam. This drug resistance was due to an extended-spectrum class C beta-lactamase encoded by chromosomal gene(s). The GC3 beta-lactamase showed high amino acid sequence homology to a known C. freundii beta-lactamase, i.e., 346 of 361 amino acids were identical with those of C. freundii GN346 beta-lactamase (Tsukamoto, K. et al, Eur. J. Biochem. 188, 15-22, 1990). Asp198 was the only dissimilar amino acid found in the omega loop region, known as the hot spot for extended-spectrum resistance in class C beta-lactamases (Haruta, S. et al, Microbiol. Immunol. 42, 165-169, 1998). However, Asp198 was eliminated as a cause of the extended-spectrum resistance by the substitution of Asn for Asp198. Subsequent investigation suggested that the moderate resistance to oxyimino beta-lactams is attributable to the replacement of amino acids on the enzyme's surface area, far from the active-site. Some or all of the replacements are assumed to delicately modify the active-site configuration. The GC3 beta-lactamase is the first example of an extended-spectrum class C beta-lactamase in which mutations are independent of the omega loop.     

肠杆菌科细菌产金属β-内酰胺酶的研究进展

肠杆菌科细菌是社区获得性感染和院内感染的重要病原菌,近年来由于抗生素的大量、不合理使用,导致临床肠杆菌科细菌耐碳青霉烯类抗生素情况日趋严重,其中产金属β-内酰胺酶是导致细菌耐药的主要机制之一.本研究就对碳青霉烯类抗生素耐药的肠杆菌科细菌产生的金属β-内酰胺酶的研究进展作一综述.     

The beta-lactamase threat in Enterobacteriaceae, Pseudomonas and Acinetobacter

Over the past 60 years, the use of successive generations of beta-lactam antibiotics has selected successive generations of beta-lactamase enzymes, each more potent than the last. Currently, rising problems include CTX-M extended-spectrum beta-lactamases (ESBLs), plasmid-mediated AmpC beta-lactamases and KPC carbapenemases in Enterobacteriaceae, while OXA- and metallo- carbapenemases are of growing importance in Acinetobacter spp. and (less so) in other non-fermenters. Escherichia coli isolates with CTX-M ESBLs are spreading multiresistance in the community and in hospitals, while carbapenemase-producing Acinetobacter spp., mostly from intensive care, are among the most multiresistant nosocomial bacteria known and are often susceptible only to polymyxins and, potentially, tigecycline. This review discusses the epidemiology and microbiology of these resistance problems, along with possible solutions.     

Recovery of beta-lactamase producing bacteria in pediatric infections

The presence of beta-lactamase producing bacteria (beta LPB) was investigated in specimens obtained from 1469 children who presented with infections of the skin and soft tissue (648), upper respiratory tract (514), pulmonary sites (137), surgical sites (113), and other (57). Of 4989 bacterial isolates recovered, 910 (18%) were beta LPB, 492 (54%) aerobes, and 418 (46%) anaerobes. The beta LPB were recovered in 751 (51%) of the children. The most frequently recovered beta LPB was Staphylococcus aureus, which was recovered in 356 (47%) patients. Most isolates were recovered from patients with skin and soft-tissue infections (68% of patients), upper respiratory tract infections (49%), and pulmonary infections (35%). Bacteroides fragilis group was isolated in 35% of patients with beta LPB, mostly from surgical infections (98% of patients), pulmonary infections (36%), skin and soft-tissue infections (25%), and upper respiratory tract infections (20%). Twenty-five percent of the Bacteroides melaninogenicus group produced beta-lactamase. These organisms were recovered in 15% of patients with beta LPB. They were recovered in upper respiratory tract infections (38% of patients), pulmonary infections (22%), and skin and soft-tissue infections (7%). Other beta LPB were Pseudomonas aeruginosa (8% of total patients with beta LPB), Escherichia coli (4%), Bacteroides oralis (3%), Klebsiella pneumoniae (3%), Haemophilus influenzae (2%), Proteus (1%), and Branhamella catarrhalis (1%). The role of beta LPB in the failure of penicillin to eradicate many of the infections is discussed.     

Structure of an extended-spectrum class A beta-lactamase from Proteus vulgaris K1

The structure of a chromosomal extended-spectrum beta-lactamase (ESBL) having the ability to hydrolyze cephalosporins including cefuroxime and ceftazidime has been determined by X-ray crystallography to 1.75 A resolution. The species-specific class A beta-lactamase from Proteus vulgaris K1 was crystallized at pH 6.25 and its structure solved by molecular replacement. Refinement of the model resulted in crystallographic R and R(free) of 16.9 % and 19.3 %, respectively. The folding of the K1 enzyme is broadly similar to that of non-ESBL TEM-type beta-lactamases (2 A rmsd for C(alpha)) and differs by only 0.35 A for all atoms of six conserved residues in the catalytic site. Other residues promoting extended-spectrum activity in K1 include the side-chains of atypical residues Ser237 and Lys276. These side-chains are linked by two water molecules, one of which lies in the position normally filled by the guanidinium group of Arg244, present in most non-ESBL enzymes but absent from K1. The ammonium group of Lys276, ca 3.5 A from the virtual Arg244 guanidinium position, may interact with polar R2 substitutents on the dihydrothiazene ring of cephalosporins.     

Characterisation of local isolates of Enterobacteriaceae from Turkey

20 local isolates of enterics belonging to the genera Salmonella, Enterobacter, Proteus, Citrobacter from human, chicken and/or egg were characterised for their antibiotic resistance patterns, plasmid profiles, phage types, outer membrane proteins, and lipopolysaccharide patterns. Relatedness of these characteristics for epidemiological analysis was assessed. 18 (90%) strains were resistant to at least one antibiotic and those (multi-drug resistant ones) resisting to two or more antibiotics constituted 50% of all isolates. A common 54 kb plasmid was harboured by 55% of the isolates. 14 isolates showed smooth type lipopolysaccharide. 60% of the 20 isolates contained outer membrane proteins in a molecular weight range of 34.6 to 30.6 kDa. The data reveal the lack of correlation between the characteristics investigated.     

Occurrence of qnr-positive clinical isolates in Klebsiella pneumoniae producing ESBL or AmpC-type beta-lactamase from five pediatric hospitals in China.

The plasmid-mediated quinolone resistance qnr genes in clinical isolates in adults have been described in different countries; however, the frequency of their occurrence has not been detected in pediatric patients. A total of 410 clinical isolates of Klebsiella pneumoniae, identified as producers of an extended-spectrum beta-lactamase (ESBL), or AmpC beta-lactamase, were collected from five children's hospitals in China during 2005-2006. The isolates were screened for the presence of the qnrA, qnrB, and qnrS genes, and then the harboring qnr gene isolates were detected for a bla gene coding for the TEM, SHV, CTX-M, and plasmid-mediated ampC gene by a PCR experiment. Ninety-two isolates (22.7%) were positive for the qnr gene, including 10 of qnrA (2.4%), 25 of qnrB (6.1%), and 62 of qnrS (15.1%). Eighty-one of the 92 (88.0%) qnr-positive isolates carried at least one bla gene for TEM, SHV, CTX-M, or DHA-1. The ciprofloxacin resistance increased 16-256-fold and oflaxacin resistance increased 2-32-fold in transconjugants, respectively. These results indicated that the plasmid-mediated qnr quinolone resistance gene was qnrS, followed by qnrB and qnrA. Most of the isolates also carried a bla gene coding ESBL or ampC gene coding DHA-1 among Klebsiella pneumoniae isolated from Chinese pediatric patients.     

IS1999 increases expression of the extended-spectrum beta-lactamase VEB-1 in Pseudomonas aeruginosa

The integron-borne bla(VEB-1) gene encodes an extended-spectrum beta-lactamase. This gene was associated mostly with IS1999 and rarely with an additional IS2000 element in Pseudomonas aeruginosa isolates from Thailand, whereas IS1999 was only very rarely associated with bla(VEB-1) in Enterobacteriaceae. Expression experiments and promoter study identified promoter sequences in IS1999 that increased the expression of VEB-1 in P. aeruginosa.     

Thermophilic bacterial isolates producing lipase

Abstract A number of lipase-producing thermophilic bacteria were isolated from natural habitats. One isolate, obtained from a coal tip sample, was examined in some detail: it was a highly thermophilic Bacillus sp. (optimum growth temperature approx. 65°C) and at 55°C it produced the maximum level of lipase (about 4 U/ml) in a medium containing Tween-80 (polyoxyethylene sorbitan monooleate) as the principal carbon source when growth had virtually ceased. Lipase synthesis thus appears to be inducible, and since a very low level of lipase was observed when the isolate was grown in a medium containing a carbon source like glucose as well as Tween-80, lipase synthesis is apparently also subject to catabolite repression.