喹诺酮类药物的抗菌活性与细菌耐药性研究进展

喹诺酮类药物（quinolones,QLs）是一类化学合成的抗菌药物,曾在世界范围内广泛应用于临床细菌病的治疗。其作用靶点为细菌DNA螺旋酶和拓扑异构酶,形成药-酶-DNA三元复合体,阻止蛋白质合成,从而达到抑菌效果。目前,通过对许多三元复合体的晶体结构解析,以及非催化镁离子模型的建立,进一步合理地解释了喹诺酮类药物活性受到影响的现象。临床常见致病菌对喹诺酮类药物产生耐药现象的机理研究较多,主要是基因突变、膜对药物的通透性改变及质粒介导的喹诺酮耐药性（PMQR）3个方面。文章主要对喹诺酮类药物的作用机制和细菌耐药机理进行综述,以期为后期喹诺酮类药物结构优化提供更多的信息支持。     

喹诺酮类药物耐药机制研究进展

喹诺酮类属于合成的广谱抗菌药,用于治疗与肠杆菌科相关的各种感染性疾病.近几十年来,喹诺酮类药物的广泛使用和过度使用导致了喹诺酮耐药菌株的出现.喹诺酮类药物耐药的产生是一个复杂的多因素过程,主要的耐药机制包括染色体介导的一个或多个靶点基因突变改变靶点酶的药物结合力;Ac-rAB-tolC多耐药外排泵的过表达和孔蛋白的改变...     

质粒介导喹诺酮类耐药机制研究进展

质粒介导喹诺酮类耐药(PMQR)基因的出现,迅速提高了细菌对喹诺酮类药物的耐药性,给临床细菌性疾病的治疗带来了严重的威胁。目前虽然认为喹诺酮类耐药基因(qnr)只引起低水平耐药,但低水平耐药性可使细菌数量达到出现突变所需的浓度,从而出现高水平耐药。因此,对质粒介导该类药物耐药机制的研究,及耐药基因的分子传播机制的研究不仅能指导临床合理用药,而且有助于控制耐药菌株的产生和传播。     

Quinolone resistance in Escherichia coli.

Escherichia coli is an important pathogen of animals and humans that causes great financial cost in food production by causing disease in food animals. The quinolones are a class of synthetic antimicrobial agents with excellent activity against Escherichia coli and other Gram-negative bacteria used in human and veterinary medicine. Different quinolones are used to treat various conditions in animals in different parts of the world. All members of this class of drug have the same mode of action: inhibition of topoisomerase enzymes, DNA Gyrase and Topoisomerase IV. Escherichia coli can become resistant to quinolones by altering the target enzymes, reducing permeability of the cell to inhibit their entry, or by actively pumping the drug out of the cell. All these resistance mechanisms can play a role in high-level fluoroquinolone resistance, however target site mutations appear to be most important. As all quinolones act in the same way resistance to one member of the class will also confer decreased susceptibility to all members of the family. Quinolone resistant Escherichia coli in animals have increased in numbers after quinolone introduction in a number of different case studies. The resistance mechanisms in these isolates are the same as those in resistant strains found in humans. Care needs to be taken to ensure that quinolones are used sparingly and appropriately as highly resistant strains of Escherichia coli can be selected and may pass into the food chain. As these drugs are of major therapeutic importance in human medicine, this is a public health concern. More information as to the numbers of quinolone resistant Escherichia coli and the relationship between resistance and quinolone use is needed to allow us to make better informed decisions about when and when not to use quinolones in the treatment of animals.     

PREVALENCE AND CHARACTERIZATION OF QUINOLONE RESISTANCE GENES IN PROTEUS SPECIES ISOLATED FROM PET TURTLES

Proteus spp. are widely recognized as opportunistic pathogens causing urinary tract and septic infections in humans and animals. The aim of this study was to investigate the prevalence of plasmid-mediated quinolone resistance genes and mutations in the quinolone resistance determining region in association with the detection of quinolone susceptibility of 24 strains of pet turtle-borne Proteus spp. Susceptibility of 4 antimicrobials including nalidixic acid, ciprofloxacin, ofloxacin, and levofloxacin was examined by disk diffusion and minimum inhibitory concentration test. Six isolates were resistant to nalidixic acid showing either intermediate resistance or resistance to other quinolones. All nalidixic acid, resistant isolates harbored mutations in gyrB (N440T/A401G/Q411S). Two of the isolates had both gyrA (S83I) and parC (S80I) mutations. Twenty-one isolates were positive for the presence of plasmid-mediated quinolone resistance genes; the qnrD gene had the highest prevalence with 19 (79.2%), while qnrS, qnrA, qnrB, and aac(6′), Ib-cr genes were present in 9 (37.5%), 2 (8.3%), 1 (4.2%), and 11 (45.8%) isolates, respectively. These results suggest that pet turtle-associated Proteus spp. should be considered a potential source of antimicrobial resistance determinants.     

Prevalence and characteristics of quinolone resistance in Escherichia coli in veal calves

Quinolone resistance is studied and reported increasingly in isolates from humans, food-producing animals and companion animals. Resistance can be caused by chromosomal mutations in topoisomerase genes, plasmid-mediated resistance genes, and active transport through efflux pumps. Cross sectional data on quinolone resistance mechanisms in non-pathogenic bacteria from healthy veal calves is limited. The purpose of this study was to determine the prevalence and characteristics of quinolone resistance mechanisms in Escherichia coli isolates from veal calves, after more than 20 years of quinolone usage in veal calves. MIC values were determined for all isolates collected as part of a national surveillance program on antimicrobial resistance in commensal bacteria in food-producing animals in The Netherlands. From the strains collected from veal calves in 2007 (n=175) all isolates with ciprofloxacin MIC ≥ 0.125 mg/L (n=25) were selected for this study, and screened for the presence of known quinolone resistance determinants. In this selection only chromosomal mutations in the topoisomerase type II and IV genes were detected. The number of mutations found per isolate correlated with an increasing ciprofloxacin MIC. No plasmid-mediated quinolone resistance genes were found. The contribution of efflux pumps varied from no contribution to a 16-fold increase in susceptibility. No correlation was found with the presence of resistance genes of other antimicrobial classes, even though all quinolone non-wild type isolates were resistant to 3 or more classes of antibiotics other than quinolones. Over twenty years of quinolone usage in veal calves in The Netherlands did not result in a widespread occurrence of plasmid-mediated quinolone resistance, limiting the transmission of quinolone resistance to clonal distribution.     

Mechanisms of quinolone resistance in Salmonella.

As in other Gram-negative bacteria, mechanisms of resistance to quinolones in Salmonella include target gene mutations, active efflux, and decreased outer membrane permeability. However, the exact contribution of these individual mechanisms to resistance, which may nevertheless interplay to reach high-level resistance, has not yet clearly been defined as in other bacteria such as Escherichia coli. This paper reviews the current state of knowledge of quinolone resistance mechanisms in Salmonella by comparison with that of E. coli and future directions of research with particular attention to the recent development of efflux pump inhibitors as possible means of avoiding the emergence and spread of fluoroquinolone resistance.     

2012~2013年山东省禽源大肠杆菌中质粒介导喹诺酮类药物耐药基因的检测

为研究近年来山东省禽源致病性大肠杆菌中质粒介导喹诺酮类药物耐药(plasmid-mediated quinolone resistance,PMQR)基因的基因型分布,及其对喹诺酮类抗生素的耐药性的影响,分别采用针对qnrA、qnrB、qnrC、qnrD、qnrS、oqxA、oqxB与qepA 8个耐药基因的通用引物,对93株2012~2013年分离自山东省的禽源大肠杆菌进行PCR检测,并对其进行了5种喹诺酮类药物的药敏试验。结果表明山东省禽源大肠杆菌对5种喹诺酮类抗生素均产生了较高耐药性(50.54%~86.30%);PMQR基因携带率达到60.21%(56/93),其中26.88%(25/93)的菌株携带2种PMQR基因,1.07%(1/93)的菌株携带3种PMQR基因;qnrA、qnrB、qnrC、qnrD与qepA基因未被检测到,qnrS、oqxA和oqxB基因在山东省禽源致病性大肠杆菌中分布较为广泛,其检出率依次为22.58%(21/93)、40.86%(38/93)和24.73%(23/93)。     

In vitro evaluation of various quinolone antibacterial agents against veterinary mycoplasmas and porcine respiratory bacterial pathogens

The in vitro activities of 12 quinolones and four antibiotics were determined against 15 veterinary mycoplasmal species and four species of bacteria commonly involved in respiratory infections in pigs. The newer quinolones were markedly more active in vitro against a wide range of mycoplasmas than nalidixic acid and the earlier quinolones. Against Mycoplasma hyopneumoniae ciprofloxacin was the most active quinolone with a geometric mean minimal inhibitory concentration (MIC) against 16 strains of 0.01 microgram ml-1 compared with 0.04 microgram ml-1 for tiamulin, 0.06 microgram ml-1 for tylosin, 0.17 microgram ml-1 for oxytetracycline and 0.23 microgram ml-1 for gentamicin. M hyosynoviae was less sensitive to the quinolones with mean MICs of 0.6 microgram ml-1 for ofloxacin and 0.7 microgram ml-1 for ciprofloxacin compared with 0.034 microgram ml-1, or less, for tiamulin. Norfloxacin and its 6-chloro analogue were both mycoplasmacidal in vitro at five or 10 times their MICs against M hyopneumoniae UCD4. Tiamulin was mycoplasmastatic. The quinolones were also active against porcine Bordetella bronchiseptica and Pasteurella multocida strains and Haemophilus species. Ciprofloxacin was the most active quinolone with mean MICs of 0.58 microgram ml-1 against B bronchiseptica (nine strains), 0.026 microgram ml-1 against P multocida (five strains) and 0.01 microgram ml-1, or less, against Haemophilus pleuropneumoniae (nine strains) and H parasuis (two strains) compared with mean MICs of from 0.5 microgram ml-1 to 64 micrograms ml-1, or more, for the antibiotics. This combination of excellent mycoplasmacidal activity against M hyopneumoniae and good antibacterial activity, suggests that the quinolones have great potential for treating respiratory infections in pigs, including enzootic pneumonia.     

Molecular basis of quinolone resistance in Escherichia coli from wild birds

Nine quinolone resistant (minimal inhibitory concentration [MIC] was > 32 microg/mL for nalidixic acid, > 1 microg/mL for ciprofloxacin) isolates of Escherichia coli have been found in wild birds with septicemia. All of the isolates were aerobactin positive. The mechanisms of resistance were characterised by sequencing the quinolone resistance-determining region (QRDR) of the gyrA, gyrB, parC, and parE genes. Sequence analysis of the gyrA gene in all isolates identified only 1 nucleotide substitution at codon Serine-83 for Leucine-83. Sequence analysis of the gyrB, parC, and parE QRDR genes revealed no mutations in any of the isolates. This study was conducted to determine the importance of these genes in the susceptibility of E. coli strains isolated from wild birds to quinolones.     

救必应中药血清与抗菌药联合对产ESBLs细菌抑菌效果的研究

本试验主要探讨救必应中药血清与抗菌药联合诱导细菌传代的体外抑菌活性。制备救必应中药血清,采用二倍微量稀释法体外检测抗菌药的最小抑菌浓度(MIC),然后救必应中药血清与抗菌药联合诱导产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)细菌传代。救必应中药血清与抗菌药联合诱导细菌传代对耐药大肠杆菌有不同程度的抑菌活性。救必应中药血清可明显地增强β-内酰胺类抗菌药、氨基糖苷类抗菌药、喹诺酮类抗菌药和卡巴氧类抗菌药对耐药菌的抑制作用。     

副猪嗜血杆菌对喹诺酮类药物流行病学临界值的建立

为了解副猪嗜血杆菌对喹诺酮类药物的耐药现状，制定副猪嗜血杆菌对喹诺酮类药物的流行病学临界值，本试验根据CLSI-VET中规定的方法，对ScienceDirect、PubMed、中国知网等数据库中副猪嗜血杆菌对喹诺酮药物的耐药数据进行收集，共收集到605株环丙沙星、74株氧氟沙星、322株左氧氟沙星、211株达氟沙星、276株萘啶酸、143株洛美沙星、638株恩诺沙星及262株马波沙星的最小抑菌浓度数据，进行数据修正后利用统计软件ECOFFinder进行整理拟合，得出MIC拟合直方分布图，确定了副猪嗜血杆菌对8种喹诺酮类药物的流行病学临界值和耐药率。8种药物中可用于兽医临床使用的药物为达氟沙星、恩诺沙星、马波沙星、环丙沙星；萘啶酸作为第1代喹诺酮抗菌药，已基本退出市场；另外3种药物不可用于兽医临床。通过调查研究得出副猪嗜血杆菌对氧氟沙星、萘啶酸、洛美沙星、左氧氟沙星、环丙沙星、达氟沙星、马波沙星、恩诺沙星药物的流行病学临界值分别为8、4、4、0.25、0.25、0.0625、0.0625和0.03125 μg/mL，说明目前野生型副猪嗜血杆菌对环丙沙星、达氟沙星、马波沙星和恩诺沙星这4种兽医临床可用药敏感性较高，临床推荐使用。文章得出的数据在国际交流频繁的时代普遍适用，在国内外缺乏相应药效学折点和临床折点时可作为敏感和耐药的判定标准，并为进一步制定临床折点，指导临床用药、延长喹诺酮药物的临床使用寿命奠定了基础。     

不同动物源大肠杆菌的耐药性调查

为了解畜禽源大肠杆菌的耐药状况,2011—2012年从患病和健康食品动物中分离鉴定大肠杆菌935株,包括健康猪源606株、患病猪源114株、患病鸡源51株、患病水禽源(鸭和鹅)164株。试验采用琼脂稀释法测定了不同动物来源的大肠杆菌对15种抗菌药物的敏感性。结果发现,大肠杆菌耐药严重,对大部分药物的耐药率超过70.0%,其中氨苄西林、复方新诺明和四环素的耐药率均达到了80.0%以上;仅对头孢西丁、黏菌素和阿米卡星较敏感,但患病水禽源大肠杆菌对阿米卡星的耐药率达到了52.4%,明显高于其他动物。健康畜禽源大肠杆菌对多数抗菌药的耐药率低于患病畜禽源大肠杆菌,表明抗菌药物的使用增加了病原菌对第3代头孢类药物和氟喹诺酮类药物的耐药率,势必增加临床治疗难度。     

Emerging antimicrobial resistance in commensal Escherichia coli with public health relevance

In 2009, 1462 Escherichia coli isolates were collected in a systematic resistance monitoring approach from primary production, slaughterhouses and at retail and evaluated on the basis of epidemiological cut-off values. Besides resistance to antimicrobial classes that have been extensively used for a long time (e.g. sulphonamides and tetracyclines), resistance to (fluoro)quinolones and third-generation cephalosporins was observed. While in the poultry production chain the majority (60%) of isolates from laying hens was susceptible to all antimicrobials tested, most isolates from broilers, chicken meat and turkey meat showed resistance to at least one (85-93%) but frequently even to several antimicrobial classes (73-84%). In the cattle and pig production chain, the share of isolates showing resistance to at least one antimicrobial was lowest (16%) in dairy cows, whereas resistance to at least one antimicrobial ranged between 43% and 73% in veal calves, veal and pork. Resistance rates to ciprofloxacin and nalidixic acid in isolates from broilers were 41.1% and 43.1%, respectively. Likewise, high resistance rates to (fluoro)quinolones were observed in isolates from chicken meat and turkey meat. In contrast, ciprofloxacin resistance was less frequent in E.?coli isolates from the cattle and pig production chain with highest rate in veal calves (13.3%). Highest resistance rates to cephalosporins were observed in broilers and chicken meat, with 5.9% and 6.2% of the isolates showing resistance. In dairy cattle and veal, no isolates with cephalosporin resistance were detected, whereas 3.3% of the isolates from veal calves showed resistance to ceftazidime. Resistance to (fluoro)quinolones and cephalosporins in E.?coli isolates is of special concern because they are critically important antimicrobials in human antimicrobial therapy. The emergence of this resistance warrants increased monitoring. Together with continuous monitoring of antimicrobial usage, management strategies should be regularly assessed and adapted.     

氟喹诺酮类药物的耐药现状及对策

氟喹诺酮类药物因其广谱高效、吸收好、体内分布广及耐药性小等特点已成为临床治疗感染性疾病的主要药物之一。但由于盲目及不合理应用,使得其耐药性近年来呈蔓延增长趋势,且耐药机制愈来愈复杂多样。文章就近年氟喹诺酮类药物耐药性的发展及其特点作了综述,并分析了其耐药机制,提出了减缓耐药性的一些相关对策。     

Antimicrobial resistance in enteric pathogens isolated from Minnesota pigs from 1995 to 2004

This study investigated the occurrence and antimicrobial resistance profiles of Escherichia coli and Salmonella sp. isolated from swine samples submitted to the Minnesota Veterinary Diagnostic Laboratory (MVDL) in Saint Paul, Minnesota from 1995 to 2004. During this time period, a total of 5072 E. coli and 2793 Salmonella sp. was isolated. Most of these isolates were found to be resistant to the tetracycline and beta-lactam group of antibiotics. Resistance to spectinomycin was also frequently observed. An increasing trend in ampicillin resistance and a decreasing trend in apramycin resistance were seen in both pathogens, although ampicillin resistance was relatively higher in E. coli than in Salmonella. Aminoglycoside (amikacin) and quinolone (enrofloxacin) were the only antimicrobials to which minimum or no resistance was observed. The resistance of pig pathogens to several antibiotics indicates the need to routinely monitor the use of these antimicrobials and their associated resistance in pig populations.     

畜牧养殖中细菌耐药性产生机制与对策

畜牧养殖中抗菌药物耐药性问题日趋严重.细菌耐药性产生机制主要有产生钝化酶、改变药物作用靶点、通过主动外排或形成非渗透性膜、形成生物被膜、增加代谢颉颃物等.近几年研究又发现常用抗菌药的多种耐药新机制.针对细菌耐药机制,提出合理用药、加强饲养管理、研制开发耐酶药物、抗菌药物替代品、耐药抑制剂及破坏耐药基因新技术等对策,减少耐药性的产生与传播.     

Acquisition of quinolone resistance and point mutation of the gyrA gene in Campylobacter jejuni isolated from broilers and in vitro-induced resistant strains

A dramatic rise in the number of resistant Campylobacter to quinolones has been documented in human patients and domestic animals. In this study, the mechanism of acquisition of quinolone resistance was studied by detecting point mutations in the gyrA gene of Campylobacter strains obtained from broilers and strains with in vitro-induced resistance. The minimal inhibitory concentrations (MICs) of norfloxacin (NFLX) and ofloxacin (OFLX) for the strains that had no point mutation were slightly increased from the source strain (Campylobacter jejuni ATCC 33560). The MICs of nalidixic acid (NA), NFLX, and OFLX for the strains that had the point mutation at Thr-86 were 100 or 200 microg/ml, 50 microg/ml, and 25 microg/ml, respectively. The MIC of NA for the strain that had a point mutation at Asp-90 higher than those for the strains that had the point mutation at Thr-86, but the MICs of NFLX and OFLX were relatively lower than those for the strains that had point mutation at Thr-86. These findings suggest that the degree of antimicrobial resistance against NA, NFLX, and OFLX in the in vitro-induced C. jejuni strains was associated with the location of the point mutation in gyrA. On the other hand, a point mutation in all seven resistant strains isolated from broilers was located only at Thr-86, while the MICs of the three quinolones varied in each wild strain. This suggests that another mechanism might also be involved in the acquisition of quinolone resistance in C. jejuni wild strains.     

奶牛主要病原菌耐药性及控制技术研究进展

抗菌药仍是治疗病原菌引起的奶牛疾病的常用方法。抗菌药的不合理使用使得细菌产生耐药性已成为全球性的问题,应引起人们的足够重视。奶牛的主要病原菌金黄色葡萄球菌、链球菌、大肠杆菌等也显现出多重耐药的趋势,给奶牛疾病的临床治疗带来困难,同时也威胁人类健康。细菌产生耐药性的速度远超过人们研发抗菌药的速度,因此,保持现有抗菌药的疗效很有必要。一方面应该掌握细菌的耐药机制,如细菌分子耐药机制、抗菌药物外排机制或降低摄入机制、生物膜等,以便找到合适的治疗方法;另一方面采用不同措施减少耐药细菌的出现,如质粒消除、抗菌药替代品、开发高效安全的抗菌药物、临床合理用药（联合治疗）等。作者对奶牛主要病原菌的耐药情况、耐药机制、耐药控制技术进行综述,以期为减少耐药性、规范抗菌药的使用和提高治疗效果提供参考。