质粒介导碳青霉类抗生素耐药性产生的研究进展

Research progress in plasmid-mediated antibiotic resistance generation of carbapenemase

碳青霉烯类抗生素是治疗β-内酰胺酶类耐药革兰氏阴性杆菌感染的最有效手段,也是目前对抗耐药细菌最有效的抗菌药物之一。但随着碳青霉烯类耐药菌的出现,无疑给临床抗菌药物选择带来严峻的考验。临床上发现的碳青霉烯类耐药菌常含碳青霉烯酶,可分为A、B、D三类:A类为肺炎克雷伯菌碳青霉烯酶(Klebsiella pneumoniae carbapenemases,KPCs),B类为是新德里金属酶(new Delhi metalloenzyme,NDM)、亚胺培南酶(imipenemase,IMP)和维罗纳整合子金属β-内酰胺酶(verona integronencoded metallo-β-Lactamases,VIM),D类为是苯唑西林酶(Oxacillinase,OXA)。目前发现编码这些酶的基因大都位于质粒上,使得这些耐药基因能够在细菌之间进行水平或垂直传播。该文将介绍近年编码不同碳青霉烯酶的基因通过质粒的介导在革兰氏阴性杆菌中的分布、表达与传播,以期为科学防控碳青霉烯类耐药菌及合理使用抗菌药物提供理论依据。

Carbapenems are the most effective means for the treatment ofβ-lactamase-resistant Gramnegative bacilli infection,and also one of the most effective antibacterial drugs against drug-resistant bacteria at present.However,a severe ordeal of the selection of clinical antibiotics with the emergence of carbapenemase-resistant bacteria.The common clinical carbapenemases mainly include five enzymes:Klebsiella pneumoniae carbapenemases(KPCs),New Delhi metalloenzyme(NDM),Imipenemase(IMP),Verona integron-encoded metallo-β-Lactamases(VIM),and Oxacillinase(OXA).Most of the genes encoding these enzymes are located on plasmids,and plasmids allow these drug resistance genes to spread horizontally or vertically between bacteria.In this paper,the distribution,expression and dissemination of carbapenemase in Gram-negative bacteria through plasmids were reviewed in order to provide a theoretical basis for the scientific prevention and control of carbapenem-resistant bacteria and the rational use of carbapenem antibiotics.