质粒介导的喹诺酮耐药基因qnr的分类、耐药机制及其在国内的流行状况

Classification and prevalence of plasmid-mediated quinolone resistance qnr genes in China-A review

喹诺酮类抗菌药物从早期主要用于治疗尿道感染发展到后来治疗肠道感染和呼吸道感染,目前已在临床、畜牧业和水产业中广泛使用,细菌对其耐药性也逐渐呈蔓延趋势,耐药机制日趋复杂。喹诺酮类耐药机制主要分为染色体介导的耐药和质粒介导的耐药,后者对细菌耐药性的广泛传播起着重要作用。1998年首次报道了质粒介导的喹诺酮类耐药机制,即质粒上qnr基因介导的细菌对氟喹诺酮耐药机制,qnr基因可在不同细菌中迅速水平传播,引发的感染不易控制,使得院内感染大范围的流行。此外,qnr基因通常与β-内酰胺类耐药基因相关或存在于复杂整合子中与其它多重耐药基因共同整合,缩小了临床医生治疗相关细菌感染时选药或联合用药的空间,给我们带来了严峻的挑战。本文就qnr基因的发现历史、耐药机理及在国内的流行状况做了详细概述。

Quinolone antibacterial drugs, developing from the treatment of urinary tract infection in early time and now from the treatment of intestinal infection and respiratory infection, have been widely used in clinical, animal husbandry and aquaculture. Bacteria gradually become resistant to them and resistance mechanism is more and more complicated. Quinolone resistance mechanism is mainly divided into chromosome mediated resistance and plasmid mediated resistance, the latter plays an important role in spreading of antibiotic resistance. In 1998, plasmid mediated quinolone resistance mechanism was reported for the first time, namely the qnr gene mediated fluoroquinolone resistance mechanism, qnr genes can spread rapidly in different bacteria, which causes the infection difficult to control, makes the nosocomial infection popular in a wide range. In addition, qnr genes are usually associated with β- lactamase resistance gene. They exist in complex integron and integrate with the other varieties of resistance genes, which narrows the space of clinical medicine choose or drug combinations use to treat related bacterial infection and brings us a serious challenge. In this review, we provide a detailed overview for the historical discovery, classification, the resistance mechanisms of qnr genes, and the prevalence of those genes in China.