Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, People's Republic of China.
Int J Antimicrob Agents. 2013 Oct;42(4):317-21. doi: 10.1016/j.ijantimicag.2013.06.008. Epub 2013 Jul 20.
Genetic characterisation of linezolid-resistant Gram-positive cocci in a multicentre study in China has not been reported previously. To study the mechanism underlying the resistance of linezolid-resistant isolates, nine Enterococcus faecalis, one Enterococcus faecium and three Staphylococcus cohnii isolates with various levels of resistance were collected from five hospitals across China in 2009-2012. The nine E. faecalis isolates were classified into seven sequence types, indicating that these linezolid-resistant E. faecalis isolates were polyclonal. Enterococci isolates had reduced susceptibility to linezolid (MICs of 4-8 mg/L) and had mutation of ribosomal protein L3, with three also having mutation of L4, but without the multidrug resistance gene cfr or the 23S rRNA mutation G2576T. The three S. cohnii isolates were highly resistant to linezolid (MICs of 64 mg/L to >256 mg/L), harboured the cfr gene and had the 23S rRNA mutation G2576T. Southern blotting indicated that the cfr gene of these three isolates resided on different plasmids (pHK01, pRM01 and pRA01). In plasmid pHK01, IS21-558 and the cfr gene were integrated into transposon Tn558. In plasmids pRM01 and pRA01, the cfr gene was flanked by two copies of an IS256-like insertion sequence, indicating that the transferable form of linezolid resistance is conferred by the cfr gene. In conclusion, the emergence of linezolid-resistant Gram-positive cocci in different regions of China is of concern. The cfr gene and the 23S rRNA mutation contribute to high-level linezolid resistance in S. cohnii, and the L3 and L4 mutations are associated with low-level linezolid resistance in enterococci.
先前并未有报道称在中国的一项多中心研究中发现了耐(linezolid)的革兰氏阳性球菌的遗传特征。为研究耐(linezolid)分离株耐药的机制,我们从 2009 年至 2012 年在中国五个医院收集了 9 株屎肠球菌、1 株粪肠球菌和 3 株科氏葡萄球菌,这些分离株对(linezolid)的耐药程度各不相同。9 株屎肠球菌分离株被分为 7 种序列类型,表明这些耐(linezolid)屎肠球菌分离株是多克隆的。肠球菌对(linezolid)的敏感性降低(MIC 值为 4-8mg/L),核糖体蛋白 L3 发生突变,其中 3 株还发生 L4 突变,但没有多药耐药基因 cfr 或 23S rRNA 突变 G2576T。3 株科氏葡萄球菌对(linezolid)高度耐药(MIC 值为 64mg/L 至>256mg/L),携带 cfr 基因且有 23S rRNA 突变 G2576T。Southern 印迹表明,这 3 株分离株的 cfr 基因位于不同的质粒上(pHK01、pRM01 和 pRA01)。在质粒 pHK01 中,IS21-558 和 cfr 基因整合到转座子 Tn558 中。在质粒 pRM01 和 pRA01 中,cfr 基因被两个 IS256 样插入序列所包围,表明可转移的耐(linezolid)形式由 cfr 基因赋予。总之,中国不同地区出现耐(linezolid)的革兰氏阳性球菌令人担忧。cfr 基因和 23S rRNA 突变导致科氏葡萄球菌对高水平(linezolid)耐药,L3 和 L4 突变与肠球菌对低水平(linezolid)耐药有关。