乳杆菌耐药风险及其药敏检测标准

Risk of Lactobacillus drug resistance and standards for its antibiotic susceptibility test

本文简述了乳杆菌作为益生菌的商业应用情况和作为致病菌造成临床感染的致病情况及乳杆菌耐药传播风险,总结了与乳杆菌相关的4个国际权威机构对其制定的抗菌药敏试验(antimicrobial susceptibility test,AST)标准程序方法,对近15年内研究发现的乳杆菌耐药表型、基因型进行了汇总。发现在我国,对嗜酸乳杆菌、鼠李糖乳杆菌、罗伊乳杆菌和植物乳杆菌的应用最多,乳杆菌可能联合其他致病菌对免疫低下者造成合并感染,但总体而言乳杆菌的致病风险较低,乳杆菌的可转移耐药问题更值得关注,目前发现的乳杆菌的耐药基因包括tet、van、erm、mef、gyr、par、aad、aph、ant、aac、sul、dfr、cat、fex、rpo、mef和lnu等。值得关注的是,乳杆菌存在与四环素、红霉素和氯霉素相关的抗性基因(tet、erm和cat)的转移的风险,4个组织机构制定的抗菌药敏试验方法在药敏肉汤和选择测试药物上存在主要差异。

This paper briefly describes the commercial application of Lactobacillus as a probiotic,the pathogenic situation of clinical infections caused by Lactobacillus as a pathogenic bacteria,the risk of Lactobacillus drug resistance transmission.It also summarizes the standard procedure methods of the antimicrobial susceptibility test(AST)developed by four international authorities related to Lactobacillus and collects the Lactobacillus resistance phenotypes and genotypes from research in the last 15 years.It was found that in China,Lactobacillus rhamnosus,Lactobacillus acidophilus,Lactobacillus reuteri and Lactobacillus plantarum are most used.Lactobacillus may combine with other pathogenic bacteria to cause co-infection in immunocompromised people,but overall,Lactobacillus has a low risk of causing disease.The transferable drug resistance of Lactobacillus is more worthy of attention,the drug resistance genes of Lactobacillus found so far include tet,van,erm,mef,gyr,par,aad,aph,ant,aac,sul,dfr,cat,fex,rpo,mef,lnu,etc.It is concerned that the risk of transfer of resistance genes associated with tetracycline,erythromycin,chloramphenicol in Lactobacillus(tet,erm,cat),the main differences in antimicrobial susceptibility testing methods developed by the four organizing institutes are in the drug-sensitive broth and the selection of the test drug.