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基于 PCR 的方法用于屎肠球菌和乳酸肠球菌的准确鉴定和诊断。

Distinction between Enterococcus faecium and Enterococcus lactis by a PCR-Based Assay for Accurate Identification and Diagnostics.

机构信息

Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Piacenza, Italy.

UCIBIO/REQUIMTE, Applied Molecular Biosciences Unit, Department of Biological Sciences, Laboratory of Microbiology, Faculty of Pharmacy, University of Porto, Porto, Portugal.

出版信息

Microbiol Spectr. 2022 Dec 21;10(6):e0326822. doi: 10.1128/spectrum.03268-22. Epub 2022 Dec 1.

Abstract

It was recently proposed that Enterococcus faecium colonizing the human gut (previous clade B) actually corresponds to Enterococcus lactis. Our goals were to develop a PCR assay to rapidly differentiate these species and to discuss the main phenotypic and genotypic differences from a clinical perspective. The pan-genome of 512 genomes of E. faecium and E. lactis strains was analyzed to assess diversity in genes between the two species. Sequences were aligned to find the best candidate gene for designing species-specific primers, and their accuracy was tested with a collection of 382 enterococci. E. lactis isolates from clinical origins were further characterized by whole-genome sequencing (Illumina). Pan-genome analysis resulted in 12 gene variants, with gene (rhomboid protease) being selected as the candidate for species differentiation. The nucleotide sequence of diverged by 90 to 92% between sets, which allowed species identification through PCR with 100% specificity and no cross-reactivity. E. lactis strains were greatly pan-susceptible and not host specific. Hospital E. lactis isolates were susceptible to clinically relevant antibiotics, lacked infection-associated virulence markers, and were associated with patients presenting risk factors for enhanced bacterial translocation. Here, we propose a PCR-based assay using for easy routine differentiation between E. faecium and E. lactis that could be implemented in different public health contexts. We further suggest that E. lactis, a dominant human gut species, can cross the gut barrier in severely ill, immunodeficient, and surgical patients. Knowing that bacterial translocation may be a sepsis promoter, the relevance of infections caused by E. lactis strains, even if they are pan-susceptible, should be explored. Enterococcus faecium is a WHO priority pathogen that causes severe and hard-to-treat human infections. It was recently proposed that E. faecium colonizing the human gut (previous clade B) actually corresponds to Enterococcus lactis; therefore, some of the human infections occurring globally are being misidentified. In this work, we developed a PCR-based rapid identification method for the differentiation of E. faecium and E. lactis and discussed the main phenotypic and genotypic differences of these species from a clinical perspective. We identified the gene as the best candidate, based on the phylogenomic analysis of 512 published pan-genomes, and validated the PCR assay with a comprehensive collection of 382 enterococci obtained from different sources. Further detailed analysis of clinical E. lactis strains showed that they are highly susceptible to antibiotics and lack the typical virulence markers of E. faecium but are able to cause severe human infections in immunosuppressed patients, possibly in part due to gut barrier translocation.

摘要

最近有人提出,定植于人类肠道的屎肠球菌(先前的 B 群)实际上对应于乳酸肠球菌。我们的目标是开发一种 PCR 检测方法,以便快速区分这两个物种,并从临床角度讨论它们的主要表型和基因型差异。分析了 512 株屎肠球菌和乳酸肠球菌的泛基因组,以评估两个物种之间基因的多样性。对序列进行比对,以找到设计种特异性引物的最佳候选基因,并使用 382 株肠球菌的集合测试其准确性。来自临床来源的乳酸肠球菌分离株进一步通过全基因组测序(Illumina)进行了表征。泛基因组分析产生了 12 个基因变体,其中 基因(菱形蛋白酶)被选为种间分化的候选基因。两组之间的核苷酸序列差异为 90%至 92%,允许通过 PCR 进行物种鉴定,特异性为 100%,无交叉反应。乳酸肠球菌菌株对大多数抗生素高度敏感,没有宿主特异性。医院分离的乳酸肠球菌对临床相关抗生素敏感,缺乏与感染相关的毒力标记物,与具有增强细菌易位风险因素的患者有关。在这里,我们提出了一种基于 PCR 的检测方法,使用 可在不同的公共卫生环境中轻松进行屎肠球菌和乳酸肠球菌的常规区分。我们还建议,乳酸肠球菌,一种占主导地位的人类肠道物种,可以穿过肠道屏障,进入病情严重、免疫功能低下和接受手术的患者体内。鉴于细菌易位可能是脓毒症的促进因素,即使乳酸肠球菌菌株具有广泛的敏感性,也应该探索其引起的感染的相关性。屎肠球菌是世卫组织优先关注的病原体,可引起严重且难以治疗的人类感染。最近有人提出,定植于人类肠道的屎肠球菌(先前的 B 群)实际上对应于乳酸肠球菌;因此,目前全球发生的一些人类感染正在被错误识别。在这项工作中,我们开发了一种基于 PCR 的快速鉴定方法,用于区分屎肠球菌和乳酸肠球菌,并从临床角度讨论了这两个物种的主要表型和基因型差异。我们基于 512 个已发表的泛基因组的系统发育基因组分析,确定了 基因作为最佳候选基因,并使用从不同来源获得的 382 株肠球菌的综合集合验证了 PCR 检测方法。对临床乳酸肠球菌菌株的进一步详细分析表明,它们对抗生素高度敏感,缺乏屎肠球菌的典型毒力标记物,但能够在免疫抑制患者中引起严重的人类感染,这可能部分归因于肠道屏障易位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/59fe/9769498/55aa318e9150/spectrum.03268-22-f001.jpg

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