ظهور بتالاکتامازهای پلاسمیدی جدید در کلبسیلا پنومونیه

فاطمه فلاح, مژده حاکمی والا, علی هاشمی, سعید شمس

چکیده


زمينه و هدف: مقاومت آنتی‌بیوتیکی همواره به‌عنوان یک مشکل جدی برای سلامت انسان مطرح بوده است، و بیماران را در بیمارستان‌های سراسر جهان تحت تأثیر قرار مي‌دهد، از این‌رو سازمان بهداشت جهانی سال 2011 را به‌عنوان سال مقاومت آنتی‌بیوتیکی نامید. کلبسیلا پنومونیه یک پاتوژن فرصت‌طلب گرم منفی و یکی از عوامل شایع عفونت‌های بیمارستانی است. این باکتری، به‌ویژه در نوزادان باعث پنومونی، سپتی‌سمی، مننژیت، اسهال و باکتریمی می‌شود. افزایش ظهور مقاومت به چند دارو در بین ایزوله‌های بیمارستانی کلبسیلا پنومونیه؛ گزینه‌های درمانی را برای درمان عفونت‌های ایجادشده به‌وسیله این باکتری محدود کرده است. بتالاکتامازها به‌عنوان دفاع اصلی باکتری‌های گرم منفی در مقابل آنتی‌بیوتیک‌ها محسوب می‌شوند. اخیراً در برخی از باکتری‌ها، به‌ویژه کلبسیلا پنومونیه آنزیم‌های جدیدی از قبیل:

NDM-1 (New-Delhi-methallo-β-lactamase-1), OXA-48 (Oxacillinase-48), OXA-181 (Oxacillinase-181), KPC (Klebsiella pneumoniae Carbapenemase), CTX-M-15 (Cefotaximase-M-15)

 

شناسایی شده است که باعث مقاومت باکتری به بسیاری از آنتی‌بیوتیک‌ها مانند پنی‌سیلین‌ها، سفالسپورین‌ها، کارباپنم‌ها، آمینوگلیکوزیدها، ماکرولیدها، سولفامتوکسازول می‌شوند. ژن تولید‌کننده این آنزیم‌ها بر روی پلاسمیدها با اندازه‌هاي مختلف قرار داشته و قادرند از یک باکتری به باکتری دیگر، از یک انسان به انسان دیگر و حتی از یک کشور به کشور دیگر منتقل شوند. اهمیت بعضی از این ژن‌ها مانند NDM-1 و KPC  در سال 2011 به اندازه بیماری ایدز، سل و مالاریا ارزیابی شده است. این آنزیم‌ها به‌عنوان یک تهدید مهم در بیماران بستری در بیمارستان‌ها ظهور یافته‌اند. بعضی پاتوژن‌های حاوی NDM-1 و  KPCبه اشتباه ممکن است در تست‌های معمول آزمایشگاهی حساس در نظر گرفته شده و تشخیص داده نشوند، و اين خود می‌تواند منجر به این امر گردد که بیماران با دريافت آنتی‌بیوتیک‌های غیر‌مؤثر، باعث گسترش و به‌وجود آمدن پاتوژن‌های مقاوم‌تر شوند. تاكنون هیچ‌گونه واکسنی برای جلوگیری از عفونت‌های ناشی از باکتری‌های مولد کارباپنم‌آز يافت نشده است. همچنين اطلاعاتی در مورد فراوانی این ژن‌های پلاسمیدی و الگوی ژنتیکی آنها در ایران وجود ندارد. از این‌رو، تشخیص سویه‌های کلبسیلا پنومونیه حاوی آنزیم‌های مقاومت، به‌ویژه NDM-1 جهت درمان بهتر بیماران و جلوگیری از انتشار این ژن‌ها به دیگر باکتری‌ها با استفاده از روش‌های دقیق فنوتیپی و ژنوتیپی مهم می‌باشد.


موضوع


مقاومت آنتی بیوتیکی؛ بتالاكتاماز؛ پلاسمید؛ کلبسیلا

مراجع


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11th Iranian Microbiology Congress & 1 East Mediterranean Microbiology Congress Guilan University of Medical Sciences.

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