Occurrence and spread of antibiotic resistances in Enterococcus faecium
Occurrence and spread of antibiotic resistances in Enterococcus faecium
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DOI：
10.1016/s0168-1605(03)00190-9
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发表时间：
2003-12-01
影响因子：
5.4
通讯作者：
Witte, W
中科院分区：
文献类型：
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作者：
Klare, I;Konstabel, C;Witte, W
肠球菌是医院感染中的第二至第三大细菌属。尤其是肠球菌（E.）屎肠菌具有广谱的天然和获得性抗生素抗性，本文对此进行了详细介绍。从医学的角度来看，对糖肽的可转移抗性（例如，万古霉素，货车，或替考拉宁，TPL）和链阳性菌素（例如，quinupristin/dalfopristin，Q/D）在肠球菌中的作用特别令人感兴趣。肠球菌糖肽耐药的主要类型是VanA型（VAN-r、TPL-r），其主要宿主是大肠埃希菌。屎室糖肽抗性E.屎肠球菌（GREF）可以在医院和医院外发现，即在欧洲商业畜牧业中，其中糖肽阿伏泌素（AVO）过去被用作生长促进剂。在来自不同生态来源的肠球菌中存在相同类型的vanA基因簇（动物粪便样品、动物饲料、医院中的患者、社区中的人、废水样品）。显然，通过食物链（通过GREF污染的肉制品），这些多重耐药细菌或它们的vanA基因簇可以到达人类。在医院感染中，广泛流行的大肠埃希氏菌强毒力。可以出现具有或不具有糖肽抗性的相同克隆的屎肠菌分离株;这些菌株通常携带不同的质粒和ESP基因。这表明医院适应性大肠杆菌强毒力。屎肠菌株在广泛传播后，已经获得了vanA基因簇。在欧洲，维吉尼亚霉素也被用作商业畜牧业的饲料添加剂超过20年，它为耐链菌素E.屎室（SREF）。1998/1999年，在德国，SREF可从污水处理厂的废水、饲喂维吉尼亚霉素的动物粪便样本和肉制品（对Q/D交叉耐药）、社区人类粪便和临床样本中分离。这些SREF的分离发生在2000年5月在德国医院引入链阳性菌素组合Q/D用于治疗目的之前的一段时间，而其他链阳性菌素未在德国诊所使用。这似乎表明这些SREF或其链阳菌素耐药基因的来源来自医院以外的其他来源，可能来自商业畜牧业。为了防止多重耐药肠球菌或其可转移的耐药基因的传播，在人类和兽医学以及畜牧业中谨慎使用抗生素是必要的。(C)2003 Elsevier B. V.保留所有权利。
Enterococci are the second to third most important bacterial genus in hospital infections. Especially Enterococcus (E.) faecium possesses a broad spectrum of natural and acquired antibiotic resistances which are presented in detail in this paper. From medical point of view, the transferable resistances to glycopeptides (e.g., vancomycin, VAN, or teicoplanin, TPL) and streptogramins (e.g., quinupristin/dalfopristin, Q/D) in enterococci are of special interest. The VanA type of enterococcal glycopeptide resistance is the most important one (VAN-r, TPL-r); its main reservoir is E. faecium. Glycopeptide-resistant E. faecium (GREF) can be found in hospitals and outside of them, namely in European commercial animal husbandry in which the glycopeptide avoparcin (AVO) was used as growth promoter in the past. There are identical types of the vanA gene clusters in enterococci from different ecological origins (faecal samples of animals, animal feed, patients in hospitals, persons in the community, waste water samples). Obviously, across the food chain (by GREF-contaminated meat products), these multiple-resistant bacteria or their vanA gene clusters can reach humans. In hospital infections, widespread epidemic-virulent E. faecium isolates of the same clone with or without glycopeptide resistance can occur; these strains often harbour different plasmids and the esp gene. This indicates that hospital-adapted epidemic-virulent E. faecium strains have picked up the vanA gene cluster after they were already widely spread. The streptogramin virginiamycin was also used as feed additive in commercial animal husbandry in Europe for more than 20 years, and it created reservoirs for streptogramin-resistant E. faecium (SREF). In 1998/1999, SREF could be isolated in Germany from waste water of sewage treatment plants, from faecal samples and meat products of animals that were fed virginiamycin (cross resistance to Q/D), from stools of humans in the community, and from clinical samples. These isolations of SREF occurred in a time before the streptogramin combination Q/D was introduced for therapeutic purposes in German hospitals in May 2000, while other streptogramins were not used in German clinics. This seems to indicate that the origin of these SREF or their streptogramin resistance gene(s) originated from other sources outside the hospitals, probably from commercial animal husbandry. In order to prevent the dissemination of multiple antibiotic-resistant enterococci or their transferable resistance genes, a prudent use of antibiotics is necessary in human and veterinary medicine, and in animal husbandry. (C) 2003 Elsevier B.V. All rights reserved.