遗传

• 综述 •    

万古霉素耐药菌流行率及耐药机制研究进展

沈瑶1,2,3,李志宇2,缪丰诚2,肖英平3,杨华2,3,党亚丽1,马剑钢2   

  1. 1宁波大学食品科学与工程学院宁波 315832

    2湘湖实验室(农业浙江省实验室),生物技术研究院,杭州 311200

    3浙江省农业科学院农产品质量安全与营养研究所,杭州 310021


  • 收稿日期:2024-12-12 修回日期:2025-02-28 出版日期:2025-03-03 发布日期:2025-03-03
  • 基金资助:
    浙江省三农九方科技协作计划;杭州市重点科研计划项目;国家现代农业产业技术体系资助

Progresses on the prevalence and mechanism of vancomycin-resistant bacteria

Yao Shen1,2,3, Zhiyu Li2, Fengcheng Miao2, Yigping Xiao3, Hua Yang2,3, Yali Dang1,Jiangang Ma2   

  1. 1College of Food Science and Engineering, Ningbo University, Ningbo 315832China

    2Xianghu Laboratory, Institute of Biotechnology, Hangzhou 311200China

    3Institute of Quality, Safety and Nutrition of Agricultural Products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021China

  • Received:2024-12-12 Revised:2025-02-28 Published:2025-03-03 Online:2025-03-03

摘要:

万古霉素是一种糖肽类抗生素,是临床治疗耐甲氧西林金黄色葡萄球菌、肠球菌和艰难梭菌等细菌感染的最后一道防线,但目前全球多个国家和地区已发现了多种万古霉素耐药菌。基于“One health”理念,本文统计了近15年国内40个地区的人源、动物源、环境来源及食品来源的万古霉素耐药菌流行率。统计结果显示,万古霉素耐药菌主要集中于医院及周围环境。南非部分医院废水中的检出率高达96.77%;其次是巴基斯坦和中国台湾医院患者,检出率分别是56.5%29.02%;国内人源细菌万古霉素平均耐药率(1.41%)要高于国外人源(0.47%);各地区儿童患者中耐药菌的检出率较低(<1%)。值得注意的是尽管万古霉素禁止在畜禽养殖中使用,但是其耐药菌在畜禽、畜禽产品以及相关环境中都有一定的检出率,对人类健康造成一定威胁。基于统计分析结果,本文对万古霉素耐药菌的耐药及传播机制进行了综述,明确了耐药菌在“人-动物-食品-环境”流行率差异,以期解析万古霉素耐药菌在全球不同宿主中的分布和传播风险,为耐药菌的防控提供参考。

关键词: 万古霉素耐药率, 肠球菌, 金黄色葡萄球菌, 传播机制

Abstract:

Vancomycin, a glycopeptide antibiotic, serves as the last-resort treatment for infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and Clostridium difficile. However, the emergence of various vancomycin-resistant bacterial strains worldwide poses a significant challenge to clinical therapy. Adopting the "One Health" concept, we mainly present the prevalence of vancomycin-resistant bacteria over the past decade from 40 human, animal, environmental, and food sources across various regions, both domestically and internationally. The statistical results indicate that vancomycin-resistant bacteria are primarily concentrated in hospitals and their surrounding environments. The prevalence of resistant bacteria in hospital wastewater in South Africa reaches as high as 96.77%, followed by Pakistan and Chinas Taiwan region, where the resistance rates are 56.5% and 29.02%, respectively. The vancomycin average resistance rate in domestic human-source bacteria (1.41%) is overall higher than that in international human-source bacteria (0.47%). The prevalence of resistant bacteria in pediatric patients across various regions is relatively low (<1%). It is worth noting that although the use of vancomycin is prohibited in livestock farming, vancomycin-resistant bacteria can still be detected in livestock, related products and environment, posing a potential threat to human health. Based on the statistical analysis results, we summarize several common vancomycin resistance mechanisms and the transmission mechanisms, and clarify the differences in the prevalence of resistant bacteria across the 'human-animal-food-environment' interface for further analyzing the distribution and transmission risks of vancomycin-resistant bacteria in different hosts worldwide. This review can also provide references for the prevention and control of antimicrobial resistance.

Key words: vancomycin resistance rate, Enterococci, Staphylococcus aureus, mechanism of transmission