ニューヨーク市で多剤耐性菌であるMycobacterium tuberculosisのクローンファミリーの起源と州間拡散
P J Bifani1, B B Plikaytis, V Kapur
1Tuberculosis Center, Public Health Research Institute, New York, NY 10016, USA.
JAMA
|February 14, 1996
まとめ
ニューヨーク市と米国の他の場所の多剤耐性結核菌株は,Mycobacterium tuberculosisの単一ファミリーのクローン拡大を表しています. この発見は,治療が難しいこれらの感染症を管理するために,改善された結核管理戦略の必要性を強調しています.
科学分野:
- 感染症の分子疫学
- 抗菌剤耐性メカニズムに対する抗菌剤耐性のメカニズム
- 公衆衛生の微生物学
背景:
- 多剤耐性菌 (MDR) マイコバクテリアの結核菌 (M結核菌) 菌株の出現は,世界的な結核管理に重大な脅威をもたらしています.
- MDR M結核の遺伝的関連性および拡散パターンを理解することは,効果的な公衆衛生介入に不可欠です.
- 1990年代にMDR M結核によって引き起こされた広範な病気は,その起源を調査する必要がありました.
研究 の 目的:
- ニューヨーク市および米国内の他の場所から広範囲に広がるMDR M結核の単離体が,単一の新興クローンまたは多様な無関係の株を表しているかどうかを確認する.
- MDR M結核菌株の分子特性と拡散を調査し,有意な疾患負担を担当する.
主な方法:
- ニューヨークの1953人の患者と,米国の他のコミュニティの6人の患者からのM結核単離の分析.
- IS6110とポリモルフなGC豊富な反復配列 (PGRS) ハイブリダイゼーション,マルチプレックスPCR,および抵抗関連遺伝子 (rpoB, katG, inhA, strA, rrs) のDNA配列解析を用いた分子特徴付け.
- リファンピン,イソニアジド,ストレプトマイシンに対する耐性を与える変異の特定.
主要な成果:
- ニューヨーク市のMDR M結核単離は,同一または密接に関連したIS6110およびPGRSパターン,複数のPCRタイプ,および耐性遺伝子の変異を共有しました.
- フロリダ州,ネバダ州,アトランタ州,マイアミ州,デンバー州のMDR M結核単離体において,地理的な広がりを示す同一の分子プロファイルが観察されました.
- これらの密接に関連した菌株は,介護施設の環境で少なくとも12人の個人に病気や感染を引き起こしました.
結論:
- この研究は,近年の共通の祖先から生まれた,密接に関連したMDR M結核菌株のファミリーのクローン拡張と拡散を記録しています.
- MDRフェノタイプは,抗生物質の選択と不適切な治療による抗性変異の連続的な獲得から生じた可能性が高い.
- 治療が難しいこれらの菌株が米国の複数の都市に広がることは,現在進行中の結核対策に深刻な影響を及ぼします.
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