细菌对多黏菌素耐药机制及检测方法研究进展  

Research Advances in Mechanisms of Bacterial Resistance to Polymyxins and Related Detection Methods

作　　者：郭锦声 高蕾[1] 张淑艳 GUO Jinsheng;GAO Lei;ZHANG Shuyan(Medical Technology Support Department of Chinese People’s Liberation Army General Hospital,Beijing 101149,China)

机构地区：[1]中国人民解放军总医院京东医疗区医技保障科,北京101149

出　　处：《标记免疫分析与临床》2024年第9期1736-1739,共4页Labeled Immunoassays and Clinical Medicine

基　　金：我军生物安全病原监测与应用处置关键技术研究(编号:AWS16J020)。

摘　　要：多黏菌素是一组阳性多肽类抗生素,被认为是应对多重耐药革兰阴性菌感染的最后一线药物,但近年来多黏菌素临床耐药的报告日益增多,多黏菌素耐药已经成为一个严重的问题,应该给予高度关注。为便于进一步研究,本文对其耐药机制和检测方法的研究进展做了综述,分析了多黏菌素天然耐药的原因和获得性耐药的机制,并对染色体介导的LPS修饰作用、质粒介导的LPS修饰作用、异质耐药性进行了阐述,介绍耐药的检测方法,包括表型检测法、分子生物学方法。目前,临床微生物实验室有必要增加对革兰阴性菌多黏菌素耐药性的常规测定,因为多黏菌素耐药的泛耐药和全耐药菌的流行风险正在增加,一株细菌存在多种耐药机制给常规检测增加了难度,表型和分子学方法同时检测更有利于结果的解释和判断,且简单、方便,可同时检测出多种耐药机制的方法仍然值得期待。Polymyxins are polycationic antimicrobial peptides that are currently served as the last-line antibiotics for the treatment of multidrug-resistant Gram-negative bacterial infections.Reports of polymyxin resistance in clinical isolates have been recently increased,which is becoming a serious public health issue and should be of great concern.Research advances in mechanisms of bacterial resistance to polymyxins and related detection methods are introduced in this paper in order to facilitate future studies.The reason of natural to polymyxin and the mechanism of acquired resistance were analyzed,and the effects of chromosome-mediated LPS modification,plasmid-mediated LPS modification and heterogeneous resistance were discussed.This article also introduces the methods of drug resistance detection,including phenotype detection and molecular biology methods.At present,there is a need for clinical microbiology laboratories to increase routine testing for polymyxin resistance in Gram-negative bacteria.As the prevalence risk of pan-and full-resistance to polymyxin is increasing,the presence of multiple resistance mechanisms in a bacterial strain makes routine detection more difficult.The simultaneous detection of phenotype and molecular methods is easier to interpret and judge the results,and is also simple and convenient,suggesting that the possibility of simultaneous detection of multiple resistance mechanisms is to be expected.

关 键 词：多黏菌素 黏菌素 耐药机制 多重耐药 mcr基因 

分 类 号：R978.1[医药卫生—药品]