鸡支原体对氟喹诺酮类药物的耐药判定标准研究现状

随着氟喹诺酮类药物在鸡支原体疾病治疗方面的广泛和不合理应用,鸡支原体对氟喹诺酮类药物的耐药现象越来越严重。为了规范氟喹诺酮类药物在鸡支原体疾病治疗上的应用和在一定程度上减缓耐药现象的产生,有必要制定鸡支原体对氟喹诺酮类药物的耐药标准。本文以耐药判定标准为中心,介绍了其定义和制定流程;阐述了国内外支原体对氟喹诺酮类药物的耐药判定标准的相关研究,包括野生型临界值、药效学临界值和临床临界值的相关研究。最后对当前研究的不足进行反思,并提出了自己的设想,以期为减缓鸡支原体对氟喹诺酮类的耐药提供参考。     

沙门氏菌对六种氟喹诺酮类药物的敏感性试验

对鸡源、猪源、人源、食品源的沙门氏菌进行了鉴定,对敏感菌株进行了耐药性诱导;并用琼脂平板二倍稀释法,测定了6种氟喹诺酮类药物对临床分离和体外诱导的68株沙门氏菌的MIC,结果表明临床沙门氏菌对环丙沙星的耐药率达61.8%(37/60),而且6种氟喹诺酮类药物之间的交叉耐药现象非常严重.     

猪链球菌2型对氟喹诺酮类抗菌药耐药机制的初步研究

为研究猪链球菌2型(S.suis2)对氟喹诺酮类药物的耐药机制,本研究采用PCR和基因测序的方法分析氟喹诺酮类药物耐药诱导菌株的gyrA和parC喹诺酮耐药决定区(QRDR).与亲本药物敏感菌株和自然耐药菌株相应的氨基酸序列对比,所有耐药诱导菌株GyrA QRDR均无特征性的氨基酸变异;而有62.5％耐药诱导菌株(5/8)的ParC QRDR在第83位氨基酸突变为赖氨酸.应用质子能驱动型外排泵抑制剂氰氯苯腙(CCCP)与氟喹诺酮类药物联合用药后,CCCP可以使耐药诱导菌株对药物的敏感性提高8倍～32倍.交叉耐药性结果显示,耐药诱导菌株获得了氟喹诺酮类药物交叉耐药.     

鸡源性沙门氏菌临床分离株的耐药性分析

氟喹诺酮类药物在临床上被广泛使用。病原微生物对大多数喹诺酮类药物的耐药率达10％以上，有的甚至达到40％～70％。很多资料表明，沙门氏菌对氟喹诺酮类药物的耐药现象也很严重，且耐药率呈逐年升高的趋势。本试验对来源于不同地区的样本进行分离、鉴定，经过筛选，得到9株对氟喹诺酮类药物耐药水平较高的鸡源性沙门氏菌，分析了它们对10种抗菌药物的敏感性，为研究和探讨沙门氏菌的耐药机制打下了基础。     

鱼源病原菌对氟喹诺酮类药物的耐药性分析

本试验旨在了解北京地区鱼源病原菌对氟喹诺酮类药物的耐药现状,提供氟喹诺酮类药物在防制鱼类疾病上合理规范使用的依据。从北京地区具有典型症状的病鱼脏器或病灶分离出16株病原菌,采用纸片扩散法检测病原菌对7种氟喹诺酮类药物的耐药表型,运用PCR法分析病原菌的喹诺酮类耐药基因gyrA、qnrA和qnrS的携带情况。结果表明,鱼源病原菌对氟喹诺酮的耐药基因阳性率显著高于耐药表型检出率,可能耐药基因检测比耐药表型检测更能推测病原菌的耐药现状。50%的病原菌至少耐受1种氟喹诺酮类药物,87.5%的病原菌至少携带1种喹诺酮耐药基因,显示北京地区鱼源病原菌对氟喹诺酮类药物已在基因水平呈现出严重的耐药,有必要严格控制此类药物在鱼类养殖上的应用。     

耐氟喹诺酮类药物鸡源大肠杆菌gyrA基因QRDR的突变检测

用微量肉汤稀释法对180株鸡源大肠杆菌临床分离株进行了6种氟喹诺酮类药物的耐药性监测，大多数分离株对氟喹诺酮类药物表现出高耐药率（52．9％～93．30%）并呈多重耐药性。提取各菌株染色体DNA，对gyrA基因QRDR进行PCR扩增并测序。氨基序列分析结果显示：168株耐药菌株的第83位的氨基酸均发生了变异，由丝氨酸（S）变为亮氨酸（L）；对4种以上氟喹诺酮类药物有耐药性的107株分离株除第83位氨基酸发变异外，第87位氨基酸也发生了变异，88株由天冬氨酸（D）变为天冬酰氨（N），13株为酪氨酸（Y），5株变为甘氨酸（G），1株变为丙氨酸（A），由此表明鸡源大肠杆菌对氟喹诺类药物的耐药程度与gyrA基因QRDR的变异密切相关，第83位氨基酸变异是大肠杆菌现对氟喹诺酮类药物耐药的关键。     

毛皮动物大肠杆菌对氟喹诺酮类药物及中药的耐药性研究

本试验旨在了解毛皮动物源大肠杆菌的耐药性,有效控制毛皮动物细菌病的发生.针对14株分离自毛皮动物的大肠杆菌,采用PCR方法检测氟喹诺酮类耐药基因gyrA的携带情况,并对扩增得到的gyrA基因进行克隆测序和同源性分析;进一步针对gyrA基因制备地高辛标记的核酸探针,使用斑点杂交检测大肠杆菌对氟喹诺酮类药物的耐药情况;使用牛津杯法检测了大肠杆菌分离株对复方中药的敏感性.结果显示,PCR检出gyrA基因的阳性携带率为57.1%,斑点杂交检出耐氟喹诺酮类大肠杆菌的阳性率为50.0%,对复方中药的耐药率为28.6%.结果表明,毛皮动物对氟喹诺酮类药物的耐药性非常严重,对中药表现较高的敏感性,研究结果将为临床毛皮动物大肠杆菌病的防制提供依据.     

鸡源大肠杆菌对氟喹诺酮类药物的多重耐药性

利用药敏试验监测系统分析了71株鸡源大肠杆菌临床分离菌株对9种氟喹诺酮类药物的耐药性,结果表明临床分离菌株对沙拉沙星、恩诺沙星、环丙沙星、二氯沙星、单诺沙星、奥比沙星和萘定酸呈现很高的耐药性。耐药率分别为69%、69%、55％、76%、69%、76%和99%;对盖特沙星和左氟沙星有轻度的耐药性,耐药率分别为11％和13％。在71株分离菌株中,只有1株没有耐药性,对3种以上药物有耐药性的菌株占74％(52／70),对6种以上药物有耐药性的菌株占70%(49／70),呈现出多重耐药性。对耐药菌株GyrA基因QRDR氨基酸变异分析表明70株耐药菌株的第83位氨基酸均发生了变异,由丝氨酸(Serine)变为亮氨酸(Leucine)。对6种以上氟喹诺酮类药物有耐药性的49株分离株除了83位氨基酸发生变异外,其87位氨基酸也发生了变异,41株87位的氨基酸由天冬氨酸(D)变为天冬酰胺(N),6株87位的氨基酸由天冬氨酸(D)变为酪氨酸(Y),由天冬氨酸(D)变为甘氨酸和丙氨酸的各1株;对3种以下氟喹诺酮类药物有耐药性的21株87位的氨基酸没有发生变异。由此表明鸡源大肠杆菌GyrA基因QRDR区的变异与菌株对氟喹诺酮类药物的耐药程度密切相关,83位的氨基酸变异是大肠杆菌呈现对氟喹诺酮类药物耐药性的关键氨基酸。     

牛支原体氟喹诺酮类药物耐药靶位突变分析

为探讨牛支原体氟喹诺酮类药物耐药靶位的突变情况,对分离自我国多个省份的牛支原体进行氟喹诺酮类药物耐药性检测和耐药株筛选,通过对临床分离敏感株、耐药株及体外诱导高度耐药株的氟喹诺酮类药物耐药决定区(QRDR)进行测序分析,发现分离菌株中有19%(6/32株)对氟喹诺酮类药物耐药,其QRDR中均存在gyr A(Ser83Phe)或par C(Ser80Ile)的氨基酸突变;但在体外诱导的高度耐药株中QRDR突变类型则以gyr A(Ser83Phe/Tyr或Glu87Lys)和par C(Ser80Ile或Asp84Asn/Tyr)的氨基酸发生突变为主,以上靶位突变在介导牛支原体对氟喹诺酮类药物耐药水平方面是否起着决定性作用,还有待进一步证明。     

宠物源大肠杆菌对氟喹诺酮类药物的多重耐药机制研究

目的:研究分析宠物源大肠杆菌对氟喹诺酮类药物耐药性。方法 :采用荧光测定法对氟喹诺酮类药物的亲水性和疏水性,在临床分离的宠物源大肠杆菌敏感株及多重耐药株菌体内的蓄积量及葡萄糖与能量抑制剂氰氯苯对氟喹诺酮类药物在菌体内的影响。结果:能量依赖性是大肠杆菌敏感菌株与多重耐药菌株中的氟喹诺酮类药物浓度主要是通过能量依赖性进行降低,其中主要是多重耐药株菌浓度下降较快。结论:能力以来主要是大肠杆菌耐药原因之一,积蓄量减少将会导致耐药菌株在氟喹诺酮类药物中难以生存。     

Persistence of Mycoplasma gallisepticum in chickens after treatment with enrofloxacin without development of resistance

The ability of the avian pathogen Mycoplasma gallisepticum to persist despite fluoroquinolone treatment was investigated in chickens. Groups of specific pathogen free chickens were experimentally infected with M. gallisepticum and treated with enrofloxacin at increasing concentrations up to the therapeutic dose. When M. gallisepticum could no longer be re-isolated from chickens, birds were stressed by inoculation of infectious bronchitis virus or avian pneumovirus. Although M. gallisepticum could not be cultured from tracheal swabs collected on several consecutive sampling days after the end of the enrofloxacin treatments, the infection was not eradicated. Viral infections reactivated the mycoplasma infection. Mycoplasmas were isolated from tracheal rings cultured for several days, suggesting that M. gallisepticum persisted in the trachea despite the enrofloxacin treatment. The minimal inhibitory concentration (MIC) of enrofloxacin for most of the re-isolated mycoplasmas was the same as that of the strain with which the birds were inoculated. Furthermore, no mutation could be detected in the fluoroquinolone target genes. These results suggest that M. gallisepticum can persist in chickens without development of resistance despite several treatments with enrofloxacin.     

Strategic administration of enrofloxacin in poultry to achieve higher maximal serum concentrations

To achieve a higher maximal serum concentration (Cs(max)) of enrofloxacin after oral administration of 10mg/kg/day of three commercial preparations of enrofloxacin to chickens, two concentrations of the drug were tested (0.1 and 0.2%), under controlled laboratory conditions. A single oral bolus dose was delivered directly into the proventriculus of each of 240 chickens, which were equally divided into six groups: three received the customary concentration (0.1%), and three received the higher concentration. A quantitative/qualitative microbiological analytical method to determine serum concentrations of enrofloxacin and a software program to obtain pharmacokinetic variables, revealed that time vs. concentration relationships best fitted double peak shape curves, Cs(max1) and Cs(max2). Statistically significant (P>0.01) increments were obtained when 0.2% enrofloxacin oral solutions from the three different commercial preparations were administered. The increments ranged from 175% to 338% for Cs(max1) and 69% to 342% for Cs(max2). Optimal bactericidal concentrations of enrofloxacin are usually twice the value of their minimal inhibitory concentration. Although clinical trials are now required, it would appear that increments in the serum concentration of enrofloxacin may reduce to the rate at which bacterial resistance occurs and so increase clinical efficacy without affecting the cost per treatment.     

氧氟沙星对霉形体与大肠杆菌合并感染鸡的药效学研究

以试管两倍稀释法测得氧氟沙星及其对照药物恩诺沙星、洛美沙星和强力霉素对鸡败血霉形体的最小抑菌浓度分别为０．００６２５、０．０２５、０．４和０．４ｍｇ／Ｌ。５０、１００、２００ｍｇ／Ｌ氧氟沙星、５０ｍｇ／Ｌ恩诺沙星、５０ｍｇ／Ｌ洛美沙星和１００ｍｇ／Ｌ强力霉素连续５ｄ饮水给药,对人工合并感染败血霉形体和大肠杆菌病鸡的治愈率分别是９３．３％、９６．７％、９６．７％、１００％、９６．７％和８３．３％,感     

鸡源大肠杆菌质粒介导的氟喹诺酮类药物耐药基因qnrA的分子检测

对2005年~2007年从豫北地区临床分离的377株鸡源大肠杆菌进行生化鉴定,MIC值测定。被测菌株对氟喹诺酮类（FQs）药物恩诺沙星、环丙沙星和诺氟沙星均呈严重耐药,耐药率分别为94.9%、93.9%、94.9%。选取对恩诺沙星耐药（MIC>32 μg/ml）的235株大肠杆菌进行qnr基因的分子检测,结果显示仅有1株大肠杆菌（MIC=128 μg/ml）呈qnr基因阳性,经测序分析该基因命名为qnrA。     

Comparative study of the plasma pharmacokinetics and tissue concentrations of danofloxacin and enrofloxacin in broiler chickens

The plasma pharmacokinetics of danofloxacin and enrofloxacin in broiler chickens was investigated following single intravenous (i.v.) or oral administration (p.o.) and the steady-state plasma and tissue concentrations of both drugs were investigated after continuous administration via the drinking water. The following dosages approved for the treatment of chickens were used: danofloxacin 5 mg/kg and enrofloxacin 10 mg/kg of body weight. Concentrations of danofloxacin and enrofloxacin including its metabolite ciprofloxacin were determined in plasma and eight tissues by specific and sensitive high performance liquid chromatography methods. Pharmacokinetic parameter values for both application routes calculated by noncompartmental methods were similar for danofloxacin compared to enrofloxacin with respect to elimination half-life (t1/2: approximately 6-7 h), mean residence time (MRT; 6-9 h) and mean absorption time (MAT; 1.44 vs. 1.20 h). However, values were twofold higher for body clearance (ClB; 24 vs. 10 mL/min. kg) and volume of distribution at steady state (VdSS; 10 vs. 4 L/kg). Maximum plasma concentration (Cmax) after oral administration was 0.5 and 1.9 micrograms/mL for danofloxacin and enrofloxacin, respectively, occurring at 1.5 h for both drugs. Bioavailability (F) was high: 99% for danofloxacin and 89% for enrofloxacin. Steady-state plasma concentrations (mean +/- SD) following administration via the drinking water were fourfold higher for enrofloxacin (0.52 +/- 0.16 microgram/mL) compared to danofloxacin (0.12 +/- 0.01 microgram/mL). The steady-state AUC0-24 h values of 12.48 and 2.88 micrograms.h/mL, respectively, derived from these plasma concentrations are comparable with corresponding area under the plasma concentration-time curve (AUC) values after single oral administration. For both drugs, tissue concentrations markedly exceeded plasma concentrations, e.g. in the target lung, tissue concentrations of 0.31 +/- 0.07 microgram/g for danofloxacin and 0.88 +/- 0.24 microgram/g for enrofloxacin were detected. Taking into account the similar in vitro activity of danofloxacin and enrofloxacin against important pathogens in chickens, a higher therapeutic efficacy of water medication for enrofloxacin compared to danofloxacin can be expected when given at the approved dosages.     

Comparative efficacy of enrofloxacin, oxytetracycline, and sulfadimethoxine for the control of morbidity and mortality caused by Escherichia coli in broiler chickens

The purpose of the present study was to compare the ability of enrofloxacin, oxytetracycline, and sulfadimethoxine to reduce morbidity and mortality caused by Escherichia coli (colibacillosis) in broiler chickens. The chickens were raised in 80 pens (20 birds per pen) with 20 pens representing each treatment group under simulated commercial conditions that produced a colibacillosis challenge scenario. Each group of 20 randomized pens (replicates) was given one of four water treatments. Chickens that received enrofloxacin had significantly less mortality (P < 0.01), lower average gross pathology (colibacillosis) scores (P < 0.01), and better feed-conversion ratios (P < 0.05) than did chickens that received either oxytetracycline or no medication. Chickens that received enrofloxacin had significantly less mortality and lower pathology scores than those that received sulfadimethoxine and numerically lower feed conversion than the sulfadimethoxine group. Results from the present study show that enrofloxacin is superior to oxytetracycline and sulfadimethoxine for the control of morbidity and mortality caused by E. coli in broiler chickens. Our findings will help veterinarians choose and prescribe the most efficacious antimicrobial when treating colibacillosis.     

某养鸡场禽霍乱分离菌对常用抗菌药物的敏感性研究

从六安地区某养鸡场禽霍乱病鸡上分离到1株禽多杀性巴氏杆菌,采用纸片扩散法和试管稀释法分别测定了青霉素钾、土霉素、硫酸卡那霉素、硫酸庆大霉素、硫酸链霉素、复方新诺明、甲砜霉素、氟哌酸、环丙沙星和恩诺沙星等10种药物对分离菌的体外抗菌活性。结果表明分离到的禽多杀性巴氏杆菌对青霉素钾和土霉素耐药;对硫酸卡那霉素、硫酸庆大霉素、硫酸链霉素、甲砜霉素、氟哌酸敏感;对复方新诺明、环丙沙星和恩诺沙星极敏感。两种测定方法得到的结果一致。因此复方新诺敏、环丙沙星和恩诺沙星可作为目前该发病场防治禽霍乱的首选药物。     

Mutant-prevention concentrations of enrofloxacin for Escherichia coli isolates from chickens

OBJECTIVE: To investigate the development of enrofloxacin resistance among Escherichia coli isolates obtained from chickens by determining mutant-prevention concentrations (MPCs) and sequence the quinolone resistance-determining regions (QRDRs) of gyrA and parC genes in selected isolates. SAMPLE POPULATION: 15 chicken-derived E coli isolates. PROCEDURES: For all isolates, MPC and minimal inhibition concentration (MIC) of enrofloxacin were determined. The MPCs and maximum serum drug concentrations attained with enrofloxacin doses recommended for treatment of E coli infections in chickens were compared. Mutation frequencies and QRDR sequence changes in gyrA and parC were also determined. RESULTS: In 2 of 15 E coli strains, MPCs were low (0.016 and 0.062 microg/mL), MPC:MIC ratios were 2 and 4, and the GyrA and ParC proteins had no mutations. In 9 susceptible isolates with a GyrA point mutation, MPCs ranged from 2 to 16 microg/mL. For isolates with double mutations in GyrA and a single mutation in ParC, MPCs were > 32 microg/mL (several fold greater than the maximal plasma concentration of enrofloxacin in chickens); mutation frequencies were also much lower, compared with frequencies for single-mutation isolates. CONCLUSIONS AND CLINICAL RELEVANCE: For E coli infections of chickens, MPC appears to be useful for determining enrofloxacin-dosing strategies. The high MPC:MIC ratio may result in enrofloxacin-treatment failure in chickens infected with some wild-type gyrA E coli isolates despite the isolates' enrofloxacin susceptibility (MICs 0.125 to 1 microg/mL). For infections involving isolates with high MPCs, especially those containing mutations in gyrA and parC genes, treatment with combinations of antimicrobials should be adopted.     

复方恩诺沙星可溶性粉对畜禽主要致病菌的体外抑菌效果

采用纸片扩散法(K-B法)测定复方恩诺沙星可溶性粉对畜禽主要致病菌的敏感性,采用试管倍比稀释法测定复方恩诺沙星可溶性粉对畜禽主要致病菌的最小抑菌浓度(MIC)和最小杀菌浓度(MBC)。结果表明,病原性大肠埃希菌、绿脓杆菌、金黄色葡萄球菌、鸡巴氏杆菌、猪巴氏杆菌和链球菌对复方恩诺沙星可溶性粉敏感,复方恩诺沙星可溶性粉对畜禽主要致病菌的MIC为0.0279μg/mL~3.575μg/mL,MBC为0.055μg/mL~7.11μg/mL。     

乳酸恩诺沙星可溶性粉在鸡体内的药动学研究

24只苏禽黄羽肉鸡随机分成2组,分别按10 mg/kg体重剂量静注和内服乳酸恩诺沙星。测定乳酸恩诺沙星在鸡体内的药动学参数和生物利用度。恩诺沙星血药浓度数据用3p87计算机软件处理。静注乳酸恩诺沙星后的血药浓度-时间数据符合二室开放模型,主要动力学参数:t1/2α(0.45±0.16)h,t1/2β(7.02±1.42)h,CL(s)(0.38±0.10)L/kg/h,AUC(23.69±5.56)(mg/L)×h。内服乳酸恩诺沙星的血药浓度时间数据,符合有吸收因素二室模型,主要动力学参数:t1/2ka(0.60±0.01)h,t1/2ke(8.25±1.73)h,tpeak(2.44±0.17)h,Cmax(1.44±0.30)mg/L,AUC(20.74±3.80)(mg/L)×h,F 87.54%。结果表明,乳酸恩诺沙星可溶性粉在鸡体内具有吸收快、分布广、消除较慢以及内服生物利用度高的药动学特征。