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The Journal of antimicrobial chemotherapy 56건

  1. [해외논문]   Towards better antimicrobial susceptibility testing: impact of the Journal of Antimicrobial Chemotherapy   SCI SCIE

    Wootton, Mandy (Welsh Antimicrobial Resistance Programme, Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK ) , MacGowan, Alasdair P. (Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK ) , Howe, Robin A. (Welsh Antimicrobial Resistance Programme, Public Health Wales, University Hospital of Wales, Cardiff CF14 4XW, UK)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 323 - 329 , 2017 , 0305-7453 ,

    초록

    Susceptibility testing of bacteria is one of the most important tests performed in a clinical microbiology laboratory. Improvements in laboratory techniques, especially the move towards standardized susceptibility testing, has provided better consistency and accuracy of testing. When used in conjunction with the most recently developed interpretative criteria, the result is better prediction of the outcome of antimicrobial therapy for infected patients. Throughout the last four decades this Journal has published numerous articles evidencing improvements and new techniques, a valuable source of information for microbiology laboratories.

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  2. [해외논문]   Antibiotic resistance among Ureaplasma spp. isolates: cause for concern?   SCI SCIE

    Beeton, M. L. (Department of Biomedical Sciences, Cardiff Metropolitan University, Western Avenue, Cardiff CF5 2YB, UK ) , Spiller, O. B. (Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN, UK)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 330 - 337 , 2017 , 0305-7453 ,

    초록

    There is growing global concern regarding the rise of antibiotic-resistant organisms. Many of these reports have focused on various Gram-positive and Gram-negative pathogens, with little attention to the genus Ureaplasma. Ureaplasma spp. are associated with numerous infectious diseases affecting pregnant women, neonates and the immunocompromised. Treatment options are extremely limited due to high levels of intrinsic resistance resulting from the unique physiology of these organisms and further restricted in cases of the developing fetus or neonate, often limiting therapeutic options to predominantly macrolides or rarely fluoroquinolones. The increasing presence of macrolide- and fluoroquinolone-resistant strains among neonatal infections may result in pan-drug resistance and potentially untreatable conditions. Here, we review the requirements for accurate measurement of antimicrobial susceptibility, provide a comprehensive review of the antimicrobial resistance (AMR) for Ureaplasma species in the literature and contextualize these results relative to some investigators' reliance on commercial kits that are not CLSI compliant when determining AMR. The dramatic variation in the resistance patterns and impact of high levels of AMR amongst neonatal populations suggests the need for continued surveillance. Commercial kits represent an excellent tool for initial antibiotic susceptibility determination and screening. However, AMR reporting must utilize internationally standardized methods, as high-titre samples, or Mycoplasma hominis -contaminated samples routinely give false AMR results. Furthermore, there is a requirement for future reports to determine the underlying AMR mechanisms and determine whether expanding AMR is due to spontaneous mutation, transmission of resistance genes on mobile elements or selection and expansion of resistant clones.

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  3. [해외논문]   Mechanisms of action and therapeutic efficacies of the lipophilic antimycobacterial agents clofazimine and bedaquiline   SCI SCIE

    Cholo, Moloko C. (Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa ) , Mothiba, Maborwa T. (Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa ) , Fourie, Bernard (Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa ) , Anderson, Ronald (Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 338 - 353 , 2017 , 0305-7453 ,

    초록

    Drug-resistant (DR)-TB is the major challenge confronting the global TB control programme, necessitating treatment with second-line anti-TB drugs, often with limited therapeutic efficacy. This scenario has resulted in the inclusion of Group 5 antibiotics in various therapeutic regimens, two of which promise to impact significantly on the outcome of the therapy of DR-TB. These are the ‘re-purposed’ riminophenazine, clofazimine, and the recently approved diarylquinoline, bedaquiline. Although they differ structurally, both of these lipophilic agents possess cationic amphiphilic properties that enable them to target and inactivate essential ion transporters in the outer membrane of Mycobacterium tuberculosis. In the case of bedaquiline, the primary target is the key respiratory chain enzyme F 1 /F 0 -ATPase, whereas clofazimine is less selective, apparently inhibiting several targets, which may underpin the extremely low level of resistance to this agent. This review is focused on similarities and differences between clofazimine and bedaquiline, specifically in respect of molecular mechanisms of antimycobacterial action, targeting of quiescent and metabolically active organisms, therapeutic efficacy in the clinical setting of DR-TB, resistance mechanisms, pharmacodynamics, pharmacokinetics and adverse events.

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  4. [해외논문]   Linezolid: a promising option in the treatment of Gram-positives   SCI SCIE

    Zahedi Bialvaei, Abed (Department of Microbiology, Iran University of Medical Sciences, Tehran, Iran ) , Rahbar, Mohammad (Department of Microbiology, Iranian Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran ) , Yousefi, Mehdi (Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ) , Asgharzadeh, Mohammad (Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ) , Samadi Kafil, Hossein (Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 354 - 364 , 2017 , 0305-7453 ,

    초록

    Linezolid, an oxazolidinone antimicrobial agent that acts by inhibiting protein synthesis in a unique fashion, is used in the treatment of community-acquired pneumonia, skin and soft-tissue infections and other infections caused by Gram-positive bacteria including VRE and methicillin-resistant staphylococci. Currently, linezolid resistance among these pathogens remains low, commonly <1.0%, although the prevalence of antibiotic resistance is increasing in many countries. Therefore, the development of resistance by clinical isolates should prompt increased attention of clinical laboratories to routinely perform linezolid susceptibility testing for this important agent and should be taken into account when considering its therapeutic use. Considering the importance of linezolid in the treatment of infections caused by Gram-positive bacteria, this review was undertaken to optimize the clinical use of this antibiotic.

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  5. [해외논문]   Alarming increase in pretreatment HIV drug resistance in children living in sub-Saharan Africa: a systematic review and meta-analysis   SCI SCIE

    Boerma, R. S. (Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ) , Sigaloff, K. C. E. (Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ) , Akanmu, A. S. (Department of Haematology, University Teaching Hospital, University of Lagos, Lagos, Nigeria ) , Inzaule, S. (Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ) , Boele van Hensbroek, M. (Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ) , Rinke de Wit, T. F. (Amsterdam Institute for Global Health and Development & Department of Global Health, Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ) , Calis, J. C. (Global Child Health Group, Emma Children's Hospital, Academic Medical Center of the)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 365 - 371 , 2017 , 0305-7453 ,

    초록

    Background: Children have an augmented risk of pretreatment HIV drug resistance (PDR) due to exposure to antiretroviral drugs for the prevention of mother-to-child transmission (PMTCT). Paediatric data are essential to evaluate the effectiveness of the restricted number of paediatric regimens currently available, but these data are scarce. Methods: We conducted a systematic review of the literature on PDR in children (median age ≤12 years) in sub-Saharan Africa. We separately extracted the proportion of children with PDR for children with and without prior PMTCT exposure, used random-effects meta-analysis to pool proportions and used meta-regression to assess subgroup differences. Results: We included 19 studies representing 2617 children from 13 countries. The pooled PDR prevalence was 42.7% (95% CI 26.2%–59.1%) among PMTCT-exposed children and 12.7% (95% CI 6.7%–18.7%) among PMTCT-unexposed children ( P  =<I>   0.004). The PDR prevalence in PMTCT-unexposed children increased from 0% in 2004 to 26.8% in 2013 ( P  =<I>   0.009). NNRTI mutations were detected in 32.4% (95% CI 18.7%–46.1%) of PMTCT-exposed children and in 9.7% (95% CI 4.6%–14.8%) of PMTCT-unexposed children; PI mutations were uncommon (<2.5%). PDR was more common in children aged <3 years compared with children aged ≥3 years [40.9% (95% CI 27.6%–54.3%) versus 17.6% (95% CI 8.9%–26.3%), respectively ( P  =<I>   0.025)]. Conclusions: The PDR prevalence in African children is high and rapidly increasing. Even in PMTCT-unexposed children, the most recent reports indicate that PDR is present in up to a third of children starting first-line therapy. Our data underscore the importance of initiating PI-based first-line ART in young children (<3 years of age) and suggest that older children may also benefit from this approach.

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  6. [해외논문]   MRSA infections among patients in the emergency department: a European multicentre study   SCI SCIE

    Bouchiat, C. (National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France ) , Curtis, S. (Staphylococcus Reference Service, Public Health England, 61 Colindale Avenue London NW9 5EQ, UK ) , Spiliopoulou, I. (National Reference Laboratory for Staphylococci, University of Patras, University Campus, Rion 26504, Patras, Greece ) , Bes, M. (National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France ) , Cocuzza, C. (Laboratory of Clinical Microbiology and Virology, University of Milano-Bicocca, Via Cadore 48, Monza, Italy ) , Codita, I. (Cantacuzino National Institute of Research, Splaiul Independentei 103, RO-050096 Bucharest, Romania ) , Dupieux, C. (National Reference Center for Staphylococci, 59 Bd Louis Pinel, 69677 Bron cedex, Lyon, France ) , Giormezis, N. (National Reference Laboratory for Staphylococci, University of Patras, University Campus, Rion 26504, Patras, Greece ) , Kearns, A. (Staphylococcus Reference Service, Public Health England, 61 Colindale Avenue London NW9 5EQ, UK ) , Laurent, F. (National Reference Center for Staphylococci, 59 Bd Louis Pinel,) , Molinos, S. , Musumeci, R. , Prat, C. , Saadatian-Elahi, M. , Tacconelli, E. , Tristan, A. , Schulte, B. , Vandenesch, F. , Monneuse, Olivier , de Francisco, Toni , Casella, Pietro , Erbizzoni, Serena , Melzi, Sara , Oggioni, Davide , Sala, Roberta , Calaresu, Enrico , Efthimia, Petinaki , Markos, Marangos , Petinaki, Efthimia , Schroeder, Wiebke
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 372 - 375 , 2017 , 0305-7453 ,

    초록

    Background MRSA is a therapeutic concern worldwide, and a major agent of community-acquired skin and soft tissue infections (CA-SSTIs). While the US epidemiology of MRSA in CA-SSTIs is well described and reports the high prevalence of the USA300 clone, data on the European situation are lacking. Objectives To determine the prevalence and clonal characteristics of MRSA in CA-SSTIs in seven European emergency departments. Patients and methods From April to June 2015, patients presenting to the tertiary hospital emergency department with a Staphylococcus aureus CA-SSTI were prospectively enrolled. S. aureus isolates were characterized by antimicrobial susceptibility testing, detection of Panton–Valentine leucocidin encoding genes and spa -typing, MLST and/or DNA microarray. Results Two-hundred and five cases of S. aureus -associated CA-SSTIs were included, comprising folliculitis, furuncles, abscesses, paronychia, impetigo, carbuncles and cellulitis. Of the 205 cases, we report an MRSA prevalence rate of 15.1%, with a north (0%) to south (29%) increasing gradient. Fifty-one isolates were Panton–Valentine leucocidin-positive (24.9%), whether MSSA or MRSA, with a heterogeneous distribution between countries. Clonal distribution of MSSA and MRSA showed high diversity, with no predominant circulating clone and no archetypical USA300 CA-MRSA clone. Conclusions This original prospective multicentre study highlights stark differences in European MRSA epidemiology compared with the USA, and that the USA300 CA-MRSA clone is not predominant among community-infected patients in Europe.

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  7. [해외논문]   Intrinsic rifamycin resistance of Mycobacterium abscessus is mediated by ADP-ribosyltransferase MAB_0591   SCI SCIE

    Rominski, Anna (Institut fur Medizinische Mikrobiologie, Universitat Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland ) , Roditscheff, Anna (Institut fur Medizinische Mikrobiologie, Universitat Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland ) , Selchow, Petra (Institut fur Medizinische Mikrobiologie, Universitat Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland ) , Bottger, Erik C. (Institut fur Medizinische Mikrobiologie, Universitat Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland ) , Sander, Peter (Institut fur Medizinische Mikrobiologie, Universitat Zurich, Gloriastrasse 30/32, Zurich 8006, Switzerland)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 376 - 384 , 2017 , 0305-7453 ,

    초록

    Objectives: Rifampicin, a potent first-line TB drug of the rifamycin group, shows only little activity against the emerging pathogen Mycobacterium abscessus. Reportedly, bacterial resistance to rifampicin is associated with polymorphisms in the target gene rpoB or the presence of enzymes that modify and thereby inactivate rifampicin. The aim of this study was to investigate the role of the MAB_0591 ( arr Mab )-encoded rifampicin ADP-ribosyltransferase (Arr_ Mab ) in innate high-level rifampicin resistance in M. abscessus. Methods: Recombinant Escherichia coli and Mycobacterium tuberculosis strains expressing MAB_0591 were generated, as was an M. abscessus deletion mutant deficient for MAB_0591. MIC assays were used to study susceptibility to rifampicin and C25 carbamate-modified rifamycin derivatives. Results: Heterologous expression of MAB_0591 conferred rifampicin resistance to E. coli and M. tuberculosis . Rifamycin MIC values were consistently lower for the M. abscessus Δ arr Mab mutant as compared with the M. abscessus ATCC 19977 parental type strain. The rifamycin WT phenotype was restored after complementation of the M. abscessus Δ arr Mab mutant with arr Mab . Further MIC data demonstrated that a C25 modification increases rifamycin activity in WT M. abscessus . However, MIC studies in the M. abscessus Δ arr Mab mutant suggest that C25 modified rifamycins are still subject to modification by Arr_ Mab . Conclusions: Our findings identify Arr_ Mab as the major innate rifamycin resistance determinant of M. abscessus. Our data also indicate that Arr_ Mab -mediated rifamycin resistance in M. abscessus can only in part be overcome by C25 carbamate modification.

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  8. [해외논문]   A sampling and metagenomic sequencing-based methodology for monitoring antimicrobial resistance in swine herds   SCI SCIE

    Munk, Patrick (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , Andersen, Vibe Dalhoff (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , de Knegt, Leonardo (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , Jensen, Marie Stengaard (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , Knudsen, Berith Elkær (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , Lukjancenko, Oksana (Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs Lyngby, Denmark ) , Mordhorst, Hanne (Research Group for Genomic Epidemiology, National Fo) , Clasen, Julie , Agersø, Yvonne , Folkesson, Anders , Pamp, Sunje Johanna , Vigre, Hå , kan , Aarestrup, Frank Møller
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 385 - 392 , 2017 , 0305-7453 ,

    초록

    Objectives Reliable methods for monitoring antimicrobial resistance (AMR) in livestock and other reservoirs are essential to understand the trends, transmission and importance of agricultural resistance. Quantification of AMR is mostly done using culture-based techniques, but metagenomic read mapping shows promise for quantitative resistance monitoring. Methods We evaluated the ability of: (i) MIC determination for Escherichia coli ; (ii) cfu counting of E. coli ; (iii) cfu counting of aerobic bacteria; and (iv) metagenomic shotgun sequencing to predict expected tetracycline resistance based on known antimicrobial consumption in 10 Danish integrated slaughter pig herds. In addition, we evaluated whether fresh or manure floor samples constitute suitable proxies for intestinal sampling, using cfu counting, qPCR and metagenomic shotgun sequencing. Results Metagenomic read-mapping outperformed cultivation-based techniques in terms of predicting expected tetracycline resistance based on antimicrobial consumption. Our metagenomic approach had sufficient resolution to detect antimicrobial-induced changes to individual resistance gene abundances. Pen floor manure samples were found to represent rectal samples well when analysed using metagenomics, as they contain the same DNA with the exception of a few contaminating taxa that proliferate in the extraintestinal environment. Conclusions We present a workflow, from sampling to interpretation, showing how resistance monitoring can be carried out in swine herds using a metagenomic approach. We propose metagenomic sequencing should be part of routine livestock resistance monitoring programmes and potentially of integrated One Health monitoring in all reservoirs.

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  9. [해외논문]   Genetic characterization of mcr-1-bearing plasmids to depict molecular mechanisms underlying dissemination of the colistin resistance determinant   SCI SCIE

    Li, Ruichao (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China ) , Xie, Miaomiao (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China ) , Zhang, Jinfei (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China ) , Yang, Zhiqiang (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China ) , Liu, Lizhang (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China ) , Liu, Xiaobo (Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute, Shenzhen, P. R. China) , Zheng, Zhiwei , Chan, Edward Wai-Chi , Chen, Sheng
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 393 - 401 , 2017 , 0305-7453 ,

    초록

    Objectives To analyse and compare mcr-1 -bearing plasmids from animal Escherichia coli isolates, and to investigate potential mechanisms underlying dissemination of mcr-1 . Methods Ninety-seven ESBL-producing E. coli strains isolated from pig farms in China were screened for the mcr-1 gene. Fifteen mcr- 1-positive strains were subjected to molecular characterization and bioinformatic analysis of the mcr-1 -bearing plasmids that they harboured. Results Three major types of mcr-1 -bearing plasmids were recovered: IncX4 (∼33 kb), IncI2 (∼60 kb) and IncHI2 (∼216–280 kb), among which the IncX4 and IncI2 plasmids were found to harbour the mcr-1 gene only, whereas multiple resistance elements including bla CTX-M , bla CMY , bla TEM , fosA , qnrS , floR and oqxAB were detected, in various combinations, alongside mcr-1 in the IncHI2 plasmids. The profiles of mcr-1 -bearing plasmids in the test strains were highly variable, with coexistence of two mcr-1 -bearing plasmids being common. However, the MIC of colistin was not affected by the number of mcr-1 -carrying plasmids harboured. Comparative analysis of the plasmids showed that they contained an mcr-1 gene cassette with varied structures ( mcr-1 - orf , IS Apl1-mcr-1 - orf and Tn 6330 ), with the IncHI2 type being the most active in acquiring foreign resistance genes. A novel transposon, Tn 6330 , with the structure IS Apl1-mcr-1 - orf -IS Apl1 was found to be the key element mediating translocation of mcr-1 into various plasmid backbones through formation of a circular intermediate. Conclusions The mcr-1 gene can be disseminated via multiple mobile elements including Tn 6330 , its circular intermediate and plasmids harbouring such elements. It is often co-transmitted with other resistance determinants through IncHI2 plasmids. The functional mechanism of Tn 6330 , a typical composite transposon harbouring mcr-1 , should be further investigated.

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  10. [해외논문]   IncFIIk plasmid harbouring an amplification of 16S rRNA methyltransferase-encoding gene rmtH associated with mobile element ISCR2   SCI SCIE

    Beyrouthy, Racha (CHU Clermont-Ferrand, Laboratoire de Bactééériologie Clinique, Clermont-Ferrand, France ) , Robin, Frederic (CHU Clermont-Ferrand, Laboratoire de Bactééériologie Clinique, Clermont-Ferrand, France ) , Hamze, Monzer (Laboratoire Microbiologie Santéééééééééé) , Bonnet, Richard (et Environnement (LMSE), Ecole Doctorale en Sciences et Technologies et Facultééééééééééé)
    The Journal of antimicrobial chemotherapy v.72 no.2 ,pp. 402 - 406 , 2017 , 0305-7453 ,

    초록

    Objectives To investigate the resistance mechanisms and genetic support underlying the high resistance level of the Klebsiella pneumoniae strain CMUL78 to aminoglycoside and β-lactam antibiotics. Methods Antibiotic susceptibility was assessed by the disc diffusion method and MICs were determined by the microdilution method. Antibiotic resistance genes and their genetic environment were characterized by PCR and Sanger sequencing. Plasmid contents were analysed in the clinical strain and transconjugants obtained by mating-out assays. Complete plasmid sequencing was performed with PacBio and Illumina technology. Results Strain CMUL78 co-produced the 16S rRNA methyltransferase (RMTase) RmtH, carbapenemase OXA-48 and ESBL SHV-12. The rmtH - and bla SHV-12 -encoding genes were harboured by a novel ∼115 kb IncFII k plasmid designated pRmtH, and bla OXA-48 by a ∼62 kb IncL/M plasmid related to pOXA-48a. pRmtH plasmid possessed seven different stability modules, one of which is a novel hybrid toxin–antitoxin system. Interestingly, pRmtH plasmid harboured a 4-fold amplification of an rmtH -IS CR2 unit arranged in tandem and inserted within a novel IS 26 -based composite transposon designated Tn 6329 . Conclusions This is the first known report of the 16S RMTase-encoding gene rmtH in a plasmid. The rmtH -IS CR2 unit was inserted in a composite transposon as a 4-fold tandem repeat, a scarcely reported organization.

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