万古霉素耐药菌流行率及耐药机制研究进展

doi:10.16288/j.yczz.24-209

遗传 ›› 2025, Vol. 47 ›› Issue (6): 650-659.doi: 10.16288/j.yczz.24-209

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.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:2025-06-20 发布日期:2025-03-03
通讯作者: 马剑钢，博士，副研究员，研究方向：动物源细菌耐药性。E-mail:vetmajg@163.com;
党亚丽，博士，教授，研究方向：鲜味肽的呈味与协同机制、功能因子的活性评价与稳态化保持技术。E-mail: dangyali@nbu.edu.cn
作者简介:沈瑶，硕士研究生，专业方向：动物源细菌耐药性。E-mail: shenyao6267@163.com
基金资助:
浙江省三农九方科技协作计划(2023SNJF062);杭州市重点科研计划项目(2023SZD0058);国家现代农业产业技术体系项目(CARS-42-27)

Progresses on the prevalence and mechanism of vancomycin- resistant bacteria

Yao Shen¹^,²^,³(), Zhiyu Li², Fengcheng Miao², Yingping Xiao³, Hua Yang²^,³, Yali Dang¹(), Jiangang Ma²()

1. College of Food Science and Engineering, Ningbo University, Ningbo 315832, China
2. Xianghu Laboratory, Institute of Biotechnology, Hangzhou 311200, China
3. Institute of Quality, Safety and Nutrition of Agricultural Products, Zhejiang Academy of Agricultural Sciences, Hangzhou 310021, China

Received:2024-12-12 Revised:2025-02-28 Published:2025-06-20 Online:2025-03-03
Supported by:
Program of Zhejiang Agriculture and Rural Affairs(2023SNJF062);Project of the Key Scientific and Technological Program of Hangzhou(2023SZD0058);China Agriculture Research System of MOF and MARA(CARS-42-27)

摘要/Abstract

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年国内外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%和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 China’s 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

沈瑶, 李志宇, 缪丰诚, 肖英平, 杨华, 党亚丽, 马剑钢. 万古霉素耐药菌流行率及耐药机制研究进展[J]. 遗传, 2025, 47(6): 650-659.

Yao Shen, Zhiyu Li, Fengcheng Miao, Yingping Xiao, Hua Yang, Yali Dang, Jiangang Ma. Progresses on the prevalence and mechanism of vancomycin- resistant bacteria[J]. Hereditas(Beijing), 2025, 47(6): 650-659.

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菌种类型	地区	年份(采样时间)	耐药率(%)	样本来源	参考文献
肠球菌	印度	2009*	80.2	马	[20]
	意大利	2016*	49	狗	[21]
	中国甘肃	2020~2021	24.4	牛、羊、猪	[15]
	中国北京	2015~2016	1.26	伴侣动物	[32]
	欧洲	1996~2020*	14.6	伴侣动物	[33]
	南非	2011~2017	90.9	医院废水、地表水、地下水	[25~27]
	捷克	2012~2013	86.48	医院废水处理植物	[34]
	美国	2018*	50	医院污水和城市污水	[35]
	中国北京	2017	28.37	直肠拭子	[6]
	埃及	2010~2022*	50.86	临床样本	[12]
	中国台湾	2010~2020	51.08	血流感染患者	[5]
金黄色葡萄球菌	埃及	2013~2014	5.5	临床样本和鼻拭子	[36]
金黄色葡萄球菌	中国台湾	2012~2013	12.7	血液、脑脊液、腹水和胸腔积液	[4]
链球菌	马来西亚	2014~2015	100	牛肉	[37]
艰难梭菌	全球	2007~2022*	6.6	肉制品	[38]
弧杆菌	伊朗	2012~2013	95.8	家禽肉	[39]

万古霉素耐药菌流行率及耐药机制研究进展

Progresses on the prevalence and mechanism of vancomycin- resistant bacteria

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[1]	朱云颖, 王媛, 肖婷婷, 嵇金如, 沈萍, 肖永红. 杭州地区2012~2018年耐甲氧西林金黄色葡萄球菌的分子流行病学特征及其变化趋势[J]. 遗传, 2023, 45(11): 1074-1084.
[2]	崔鹏, 许涛, 张文宏, 张颖. 细菌持留与抗生素表型耐药机制[J]. 遗传, 2016, 38(10): 859-871.
[3]	杨延成,程航,周人杰,饶贤才. SCCmec遗传元件及其在耐甲氧西林金黄色葡萄球菌分子分型中的应用[J]. 遗传, 2015, 37(5): 442-451.
[4]	陈春辉,徐晓刚. 肠球菌万古霉素耐药基因簇遗传特性[J]. 遗传, 2015, 37(5): 452-457.